I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal who is the subject of this Owner Surrender Form, hereinafter referred to as “the animal” or “the pet”. I hereby relinquish all rights of ownership and any right to information on the disposition of said animal to Bastrop Animal Rescue, Inc. I certify that no other person has a right of property to the animal. I also authorize the release of any veterinary records regarding the animal. I certify that to the best of my knowledge I have disclosed all information about the animal concerning health, behavior, history and anything else that may affect the safe placement of the animal in a new home, and that all statements made below are true and correct. I further certify that I have read and understand the terms of this Owner Surrender Form.