I certify that I am the owner or duty authorized agent for the animal's owner and that no other person has any ownership or interest in this animal (if not owner or authorized agent, a notarized authorization from the owner or agent must be attached). The Animal Foundation reserves the right to make any decision it believes to be in the best interest of the animal with regards to the animal's disposition. I hereby release the Animal Foundation, its employees, agents, and representatives from any and all liability.

I understand that the animal listed above will be held for 24 hours. Depending on the outcome of a behavior and/or medical evaluation, the animal may be placed for adoption, transferred to a rescue partner or humanely euthanized. In the event of injury or illness, a Vetenarian may make a decision to humanely euthanize the animal before the end of the 24 hour hold.

I understand that should I wish to reclaim the animal within the 24 hour hold, I am responsible to pay any fees due to bring my animal into compliance with the local ordinances (including but not limited to spay/neuter, microchip, rabies or pet license.

I certify to the best of my knowledge that this animal has not bitten any person or animal in the past ten days.