Surrender Statement

By signing this surrender statement, all rights to ownership of the animal described are
relinquished.  You will not be allowed to re-adopt this animal.  In signing, you authorize Silver
Dragon Pets to make the final decision on the ultimate disposition of the animal, whether it is
adoption, euthenasia, or transfer to another rescue.

When considering adoptability through our program, we carefully examine health, temperament,
and past and/or present behavioral problems.  If an animal is found to be in severe, untreatable
pain, in the final stages of a terminal illness (cancer, organ failure, etc.), poses a danger to the
humans caring for it, or has no quality of life, it will be euthenized.  Silver Dragon Pets will do
everything medically possible to care for animals with treatable or manageable medical problems.
 Surrendering an animal to Silver Dragon Pets may put you on our "Do Not Adopt" file.

I hereby surrender the below described animal, owned solely by me, to Silver Dragon Pets.  
This animal, while in my custody, has not bitten anyone in the past 30 days.  I am supplying
copies of all veterinary paperwork, including proof of current vaccinations.  If this pet has been
surgically altered (spayed/neutered), I am including a spay/neuter certificate, or other proof the
procedure has been completed.  I am also providing proof of a negative FIV/Feline Leukemia or
heartowrm/lyme test dated no more than 60 days prior to date of surrender.

I hereby acknowledge that the following information is true and I accept total responsibility for
surrendering this animal.  If I am surrendering a cat or kitten, I understand that I have to have
this pet FIV/Feline leukemia tested, at my expense, prior to surrendering it.  I understand that
there is a surrender fee requested to help cover a portion of the veterinary, everyday care, and
feeding costs of this animal.

PLEASE PRINT
Owner's Name: ________________________________________________________
Address: _____________________________________________________________
City: _______________________________ State: ___________  Zip: ______________
Phone: (___)___________________  Cell: (___)______________________

I am surrendering this pet because: __________________________________________
________________________________________________________________________
________________________________________________________________________
Veterinarian's Name: __________________________________
Veterinarian's Phone: (___)____________________
Name records are under: ____________________________________
Medical Problems Past/Present: ______________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
I got this pet from: __________________________________________________________
I've had this pet for (how long): _______________________________________________
Microchip or Tattoo number and location: ________________________________________
Do you want your name and phone number released to the new owner adopting this pet? ______


**This form is
REQUIRED for all surrenders!