Owner Surrender
Contract
We will present this form to you
for signature in BLUE ink at the time the duck is surrendered to our sanctuary. You will need to
complete an individual form for each
Animal being surrendered.
Animal Information:
Species:
Duck
Gender:
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 |
