STOLEN HEARTS  FERRET RESCUE SURRENDER AGREEMENT

DATE: ______________________________

1. Name of Ferret:_______________________? Single_______ - Part of a group of #___________________________? Male______ - Female______ - Altered_______ Descented_______ ? Tattoo_______? Micro-chipped________ - Age________ - Date of Birth___________________? Purchase from:__________________________________ Pairs/groups will? be placed together whenever possible.

2. Vaccinations: Distemper_______ - Date ?of Last Inoculation:_____________________________?? Rabies_________- Date of Last Inoculation:____________________________ Complications: Yes_____ No_____ Explanation:_________________?________________________________________________?????????????????????

3. Medical History: Name of Vet with Ferret's Records: ___________________________________________ Address________________________________________________________              Phone_____________________________________ - Name records are under:______________________________________- Allergies: Yes____ No____ Explanation:_________________________________________________________              ____________________________________________________________________

E.C.E. Yes_____ No_____ When______________________________________ - Surgeries: Yes_____ No_____ - Explanation:________________________________?             _____________________________________________________________________              _____________________________________________________________________

4. Type of Food(s) the ferret eats:______________________________________              __________________________________________________________________???????

Type of Treats the ferret enjoys:____________________________________              ______________________________________________________________?

Type of Foods/Treats the ferret Won't Eat:___________________________              _____________________________________________________________??

5. General Care History:? Bites: Yes____No____ - Correction Method Used:?___________________________________________???____________?   ? Caged when not interacting with owners: Yes_____ No_____ -?Comments:______________________________________________________??_?___________

Enjoys baths: Yes____ No____ - How Often:_______________________________ Nail Clipping: How Often_________________________ - Familiar with other pets: Yes____ No____ Please  Identify:___________________________________________

Comfortable around children: Yes_____ - Ages___________________No_____ Around Strangers: Yes_____ No_____ - Any recent losses such as a cagemate: Yes____ No____ Explain:_____________________________________________ ???    ____________________________________________________?

6. Reason for Surrender:___________________________________________              ________________________________________________________________ ________________________________________________________________              ________________________________________________________________

TRANSFER OF OWNERSHIP

It is understood that the ferret is being surrendered for its continued welfare and that the Stolen Hearts Ferret ???Rescue Shelter accepts said ferret in an as is condition. It is further understood that the Stolen Hearts Ferret Rescue Shelter assumes full ownership, thereby full responsibility, for any current or future illness while the ferret is in the custody of the shelter. It is also understood that the surrendering party has the legal right to surrender the ferret to the shelter.

There is a reconsideration period of not more than 72 hours if requested, so that the surrendering party may rethink the decision. If a decision to reclaim the ferret is made, the owner will pay all boarding fees and any medical fees incurred during the 72-hour grace period. The ferret will not be placed before that time and can be reclaimed only by the person signing below.

Total confidentiality will be observed unless the surrendering party wishes to communicate with the adopting party. The request must be put in writing for the adopting party's acknowledgment.

The Stole?n Hearts? ?F?e?r?r?e?t? ???????????Rescue Shelter reserves the right of refusal in placing any ferret so surrendered, if, in their judgment, certain prerequisites of ownership are not met. No ferret will be placed anywhere that restricts or bans ownership of ferrets specifically or by inclusion. Nor shall any ferret be knowingly placed in a home or institution for the purpose of ritual, rite or medical experimentation.

The Stolen Hearts? ?F?e?r?r?e?t? ???????????Rescue Shelter guarantees the surrendering party that their ferret will receive the utmost in care and consideration in the placement with a new owner. Future contact with the new owner will be done in the interest of continued health and welfare concerns.

I hereby certify to the best of my knowledge that all the above information is true and complete. I give up all rights to the above named ferret.

The Stolen Hearts? ?F?e?r?r?e?t? ???????????Rescue Shelter operates as a shelter as a service to ferrets and as such is not a business.

Signed:_________________________________________ Date:_____________________              Signature of Ferret Owner

Address:_____________________________________________ Phone:___________________________________________

I agree to have communication with the adoptive party of my ferret.

Signature:__________________________________________________________________              Contact number___________________________________________________

72-Hour Grace Period Requested:______ I will advise the shelter of my decision by phone:_____

Will you be making a donation today to help with the care of your ferret? _______

Ferret Received into the shelter by:_______________________________________________ SH?F?RS No-Kill Shelter Representative

Revised: November 2003

Stolen Hearts? ?F?e?r?r?e?t? ???????????Rescue Shelter - (828) 273-7110