Release of Animal Form: Returns - Pet Haven of Minnesota

To be completed by adopters who are returning their adopted pet to Pet Haven.

Date*
MM slash DD slash YYYY
Adopter's Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Animal's Name*
Did you adopt a cat or dog?*
- Dog
- Cat
Please list any veterinary care received since adoption and the name of the vet clinic
I hereby transfer ownership of an animal to Pet Haven Inc. of Minnesota. The animal is being released to Pet Haven for the purpose of finding it a new home. Pet Haven retains sole responsibility for the selection of a new owner and to provide the veterinary care it deems appropriate during the time the animal is in the care of Pet Haven. I have received no other representations or assurances from Pet Haven as an inducement to transfer ownership. I understand that by signing this release I forfeit all property rights and claims to the animal and authorize the release of veterinary records relating to this animal to Pet Haven. I attest that this animal has not bitten anyone during the past 10 days and is not under quarantine.*
Check this box if you agree to the terms noted above.
Pet Haven Representative*
Date*
MM slash DD slash YYYY