Majestic Waterfowl Sanctuary, 17 Barker Road, Lebanon, CT, 06249

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Adoption FAQ

Owner Surrender Contract

We will present this form to you for signature in BLUE ink at the time the duck or goose is surrendered to our sanctuary. You will need to complete an individual form for each Animal being surrendered.


Animal Information:

Species:            Duck     Goose

Gender:            Male     Female     Unknown

Name of Bird:                                                                                                               

Breed:                                                                                                                          

Feather Color:                                                                                                             

Bill/Leg Color:                                                                                                              


Owner Information:

Owner's Name:                                                                                                           

Mail Address:                                                                                                              

City/State/Zip:                                                                                                            

Phone:                                                                                                                       

Email:                                                                                                                         

Co-Owner Information:

Owner's Name:                                                                                                           

Mail Address:                                                                                                              

City/State/Zip:                                                                                                            

Phone:                                                                                                                       

Email:                                                                                                                         

Even if disputed, is anyone else claiming ownership of this Animal?    Yes     No

Name:                                                                                                                         

Mail Address:                                                                                                              

City/State/Zip:                                                                                                            

Phone:                                                                                                                       

Email:                                                                                                                         

Relationship:                                                                                                              

Relevant Info:                                                                                                            

                                                                                                                                  

                                                                                                                                  

________________________________________________________________


Vet Information:

Has the Animal been treated by a vet?:   Yes     No

If yes:

Vet Practice:                                                                                                              

Vet's Name:                                                                                                                

Mail Address:                                                                                                              

City/State/Zip:                                                                                                            

Phone:                                                                                                                       

Email:                                                                                                                         

I, ___________________________________, hereby authorize the release of ALL medical records pertaining to the above listed Animal to representatives of Majestic Waterfowl Sanctuary.

____________________________    ______________________________________

Owner's Signature                               Print name clearly                               Date

I, ___________________________________, hereby authorize the release of ALL medical records pertaining to the above listed Animal to representatives of Majestic Waterfowl Sanctuary.

____________________________    ______________________________________

Co-Owner's Signature                         Print name clearly                               Date


Owner Surrender:

 

I, ___________________________________, am the undisputed owner of the Animal listed above and have full authority to surrender this Animal to Majestic Waterfowl Sanctuary. To the best of my knowledge no one will contest or dispute the surrendering of this Animal to Majestic Waterfowl Sanctuary or place any claims on the Animal or its future progeny.

I, __________________________________, hereby donate to Majestic Waterfowl Sanctuary the above listed Animal. I relinquish any and all claims to the above-listed Animal and any of the Animal's future progeny. I fully waive any and all rights, either seen or unforeseen, to and regarding this Animal.

____________________________    ______________________________________

Donor’s Signature                                Print name clearly                               Date


Co-Owner Surrender:

 

I, ___________________________________, am the undisputed co-owner of the Animal listed above and have full authority to surrender this Animal to Majestic Waterfowl Sanctuary. To the best of my knowledge no one will contest or dispute the surrendering of this Animal to Majestic Waterfowl Sanctuary or place any claims on the Animal or its future progeny.

I, __________________________________, hereby donate to Majestic Waterfowl Sanctuary the above listed Animal. I relinquish any and all claims to the above-listed Animal and any of the Animal's future progeny. I fully waive any and all rights, either seen or unforeseen, to and regarding this Animal.

____________________________    ______________________________________

Co-Donor’s Signature                           Print name clearly                               Date


For Majestic's Use Only:

The above-mentioned Animal has been accepted into Majestic Waterfowl Sanctuary's program by:

____________________________    ______________________________________

MWS Representative’s Signature          Print name clearly                              Date


 

Return to Owner Surrender Page

 

Majestic Waterfowl Sanctuary 2005, 2006, 2007, 2008, 2009

 
 

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