DCMI Surrender Form

Fill this out online to generate a ready‑to‑sign PDF. You can also download a blank copy.

Your Info

Primary Contact Name

Co‑Owner Name (optional)

Phone

Date

Animals Being Surrendered

Total number of animals

Dogs Cats Other

Physical description and ages of each animal

Known physical / emotional / behavioral issues

Has the animal ever seen a vet? Yes No

Spayed / Neutered? Yes No Some (of multiple)

Agreements

I/we wish to surrender ownership of our dog/cat to Don’t Cage Me In Animal Rescue (DCMI). I/we have not been threatened in any way; transfer of ownership/care to DCMI is our willing choice. I understand DCMI seeks immediate veterinary and foster care, then appropriate adoption placement. I fully relinquish ownership and the animal(s) will not be returned to me.

Sign & Consent

Draw your signature

Type your full legal name (required)

I agree that my typed name constitutes my electronic signature and I consent to receive, sign, and store records electronically under E‑SIGN and UETA. I am the person named above.

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Don’t Cage Me In Animal Rescue • Phone: 918‑417‑9180 • Email: DCMITULSA@gmail.com • dontcagemein.org • facebook.com/cagemenot