Owner Surrender — CTD Rescue

Owner / surrendering party

Full name * Street address *

City *

State *

ZIP *

Phone *

Email Alt phone

I am the legal owner of the animal listed

If not owner, explain relationship

Animal details

Breed / mix

Color / markings

Sex

Male Female Unknown

Spayed / neutered

Yes No Unknown

Age (approx.)

Weight

Microchipped

Yes No Unknown

Microchip # Medical conditions / medications Condition at surrender

Good Fair Poor

Condition description Behavior / feeding notes Bite or aggression history

Yes No

If yes, explain

Reason for surrender

Moving

Housing / landlord

Cost of care

Behavior

Unable to care

Other

Explanation

Release

I voluntarily and permanently transfer ownership of this animal to CTD Rescue. I understand CTD Rescue may provide veterinary care, foster, rehome, or transfer the animal at their sole discretion. This surrender is final. I certify the information is true, including any bite history, and release CTD Rescue from liability after surrender.

I have read and agree *

Owner refused to sign (staff use)

Refusal notes

Signature can be completed at pickup (online) or uploaded later if there is no internet.

Date

Security