ACADIANA HUMANE SOCIETY
Release and Surrender for Adoption
I/we the undersigned, hereby, IRREVOCABLY surrender to Acadiana Humane Society, for placement and adoption the animal described as follows:
DOG / CAT / RABBIT / OTHER: ______
Pet’s Name______sex______color______age______
Breed: ______
DOG / CAT / RABBIT / OTHER: ______
Pet’s Name______sex______color______age______
Breed: ______
DOG / CAT / RABBIT / OTHER: ______
Pet’s Name______sex______color______age______
Breed: ______
DOG / CAT / RABBIT / OTHER: ______
Pet’s Name______sex______color______age______
Breed: ______
(You may write on back of these pages if we have agreed to take more than four animals.)
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We hereby represent and warrant to Acadiana Humane Society, their agents, successors and assigns that the undersigned are the sole owner(s) of the above described animal. That I/we have full power and authority to surrender this animal for adoption and that no other person or persons have any legal or equitable ownership of this animal.
We also agree to provide Acadiana Humane Society with any documents and all other available information concerning this animal which might assist in matching this animal with the proper prospective adoptive home, including health and shot records, and information concerning this animal’s history, such as important life events and individual personality quirks.
By executing this document, we understand that we are giving up forever all right and interest to the above mentioned animal and we further understand that all future decisions regarding the placement of this animal will be made solely by Acadiana Humane Society.
I/we, the undersigned, hereby specifically and forever release, and hold Acadiana Humane Society harmless, from any and all liability arising from the placement for adoption by Acadiana Humane Society of the above mentioned animal, or for any other actions taken by Acadiana Humane Society in accordance with, and in reliance on, the representations we have made, and the authorizations we have provided under the terms of this document. We agree to indemnify and hold harmless Acadiana Humane Society for any damages suffered and expenses incurred (including legal fees) in defending any legal action, whether for bodily injuries or death, property damage, breach of contract, or otherwise. Whether instituted by us or by any other person or persons including the adoptive owners, arising out of or in consequence of the placement of the above mentioned animal, in reliance on the authorizations, representations, and warranties we have made in this agreement.
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THIS IS A LEGALLY BINDING DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR ______(AND ANY BABIES IF THE ANIMAL IS PREGNANT AT THE TIME OF SURRENDER) FOR PLACEMENT TO AN ADOPTIVE HOME.PLEASE READ CAREFULLY AND COMPLETELY BEFORE SIGNING.
TAKE AS MUCH TIME AS YOU NEED BEFORE MAKING THIS IMPORTANT DECISION.
IF YOU HAVE ANY QUESTIONS PLEASE CALL OR TEXT: 337-371-5477
I have read the preceding and agree to the conditions set forth this
______day of ______
OWNER’S NAME (Please Print)______
SIGNATURE OF OWNER______
ADDRESS______
CITY/STATE/ZIP______
TELEPHONE____home:______cell:______
e-mail address: ______
Acadiana Humane Society REPRESENTATIVE______
Donation given: yes no
If yes:US $ ______
Supplies donated: ______
______
______
Any Special Instructions or Health Information Needed? ______
______
______
______