Surrender & Rescue Form

Owner or Contact Person

Phone Number

Full Living Address (Include Village/City & Postal Code)

Full Mailing Address (Include Village/City & Postal Code)

Name of Animal

Age

Physical Description

Last Vet Visit?

Medications?

Last treated for fleas?

Last treated for ear mites?

Characteristics (what we need to know –- history, likes, dislikes, things to watch out for)

Reason for surrender or rescue?

Please check the appropriate situation:

I, the undersigned, am the owner or I have full authority on behalf of the present owner of the above noted animal, and as such, I hereby sign over any legal rights of said animal to the Gwaii Animal Helpline Society. I willingly sign over ownership of said animal, including access to past and present medical records, to the Gwaii Animal Helpline Society to continue treatment or other alternatives as they see fit.

I, the undersigned, contacted the Gwaii Animal Helpline Society to rescue said animal as I consider it to be homeless and in need of human assistance.

If you are human, leave this field blank.