This is a sample form that could be used
in a case where a "creative disposition" is desired. This
type of release should only be used as a first time pass in a case
involving the protection of an animal. It is not for repeat offenders.
Animal Relinquishment Form
On _____________________(date), I, ___________________________
(owner)
release ownership, custody, and all claim of ____________________________________
____________________________________________(name and description
of animal/s) to ______________________________________________.
I understand that in doing so, I forfeit all rights to above mentioned
animal/s.
_____ I certify that this is the first and only time I have been
charged with animal cruelty.
Additional stipulations:
____ I agree to the above in lieu of a citation.
____________(owner initial and date)
____________(witness initial and date)
____ In lieu of a citation, I agree not to obtain additional animal/s
for a period of _______.
____________(owner initial and date)
____________(witness initial and date)
____ I agree that this agreement is legal and binding.