I *ENTER NAME BELOW* an adult of legal age, do hereby voluntarily and irrevocably give, donate, surrender and release to Homes for Orphaned Pets Exist (hereinafter referred to as "H.O.P.E."), the following Animal (hereinafter referred to collectively as "Animal”).

By completing and signing this form, you are stating that you are the legal owner of the Animal(s) that all the information (to your knowledge) is true and correct.

I have disclosed to H.O.P.E. all material information regarding the medical and behavioral history of the Animal(s). I willfully surrender all medical records and information pertaining to the Animal(s). H.O.P.E. has my permission to contact my veterinarian for any necessary information pertaining to my Animal(s), and I hereby consent to the release of any and all medical information by any medical provider.

I state that all information is true and correct to the best of my ability. I further acknowledge that I am releasing the Animal(s) completely voluntarily and that no representations, considerations or promises of any kind have been made to me by H.O.P.E. I understand that by releasing the Animal(s) to H.O.P.E., I relinquish all ownership or other interest in the Animal(s). I will not seek further information about the Animal(s) and will not press H.O.P.E. for details. My contact with the Animal(s) terminates at the time of surrender. H.O.P.E. is under no obligation whatsoever to follow up with information about the Animal(s).

I hereby release and forever discharge H.O.P.E. from any and all rights, claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the Animal(s), and I agree to indemnify and hold harmless H.O.P.E. from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties.