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1250 Cox Avenue, Bainbridge, GA 39819
(229) 246-0101
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Need Assistance with a Stray Animal?
Please Contact Animal Control at 229-515-0172.
Owner Relinquish Form
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Name of Person Relinquishing Animal
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
(Required)
Cell Phone
(Required)
Description of Animal
Animal Name
(Required)
Gender of Animal
(Required)
Male
Female
Age of Animal
(Required)
How Long Have You Had this Animal?
(Required)
Species
(Required)
Cat
Dog
Breed
(Required)
Coloring/Markings
(Required)
General Condition/Temperament
(Required)
Known Medical Problems
(Required)
Has animal been spayed/neutered?
(Required)
Yes
No
When?
Where?
Has she ever had a litter?
(Required)
Yes
No
How Many Times?
Date of Last Litter?
Current on Rabies Shots?
(Required)
Yes
No
Next Due?
Other Shots?
Has animal been tested for heartworms?
(Required)
Yes
No
When?
Is animal on prevention?
(Required)
Yes
No
Next due?
Has your cat been tested for feline leukemia?
Yes
No
When?
Where?
Is your animal on flea control medicine?
Yes
No
When?
What?
Who Is Your Veterinarian?
Animal Last Seen By Vet?
Reason Last Seen:
Is Animal House-Broken Or Litter Box Trained?
Yes
No
Good With Children?
Yes
No
Good With Other Animals?
Yes
No
Has Animal Lived Primarily Inside Or Outside?
Inside
Outside
Why Are You Relinquishing This Animal?
If You Are Not The Owner Of This Animal, What Is Your Relationship To The Owner
And Why Are You And Not The Owner Bringing In The Animal?
Circumstance You Would Consider Keeping The Animal
Do You Currently Have Other Animals?
Yes
No
What kind/how many:
Location Where Animal Resided
City of Bainbridge
City of Attapulgus
City of Brinson
City of Climax
Unincorporated area of Decatur County
City of Donalsonville
City of Iron City
City of Jakin
Unincorporated area of Seminole County
City of Colquitt
City of Blakely
Unincorporated area of Miller County
City of Camilla
Unincorporated area of Mitchell County
City of Whigham
City of Cairo
Unincorporated area of Grady County
Other
Consent
(Required)
By Entering Into This Written Agreement With The Bainbridge – Decatur County Humane Society, I Am Relinquishing All Right To The Animal Described Herein. Upon Execution Of This Agreement, The Humane Society Immediately Becomes The Owner Of This Animal And, At Its Discretion, Has The Right To Either Put The Animal Up For Adoption Or Humanely Euthanize The Animal.
This Agreement Is Not Valid Until And Unless Signed By Owner And Accepted by Humane Society Representative
The Humane Society Immediately Becomes The Owner Of This Animal And, At Its Discretion, Has The Right To Either Put The Animal Up For Adoption Or Humanely Euthanize The Animal.
Please Type Name for Required Signature
(Required)
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