General InformationDate MM slash DD slash YYYY Time Hours : Minutes AM PM AM/PM Client Name Pet Name Lone Tree Animal Care where pet is being surrendered Pet and Account InformationColor/Markings: Wellness Plan Status: Payments Remaining: Cancellation Cost: Conditions and Representations of Agreement:I represent and warrant to Lone Tree Animal Care, The pet hospital that I am the sole owner of the Pet listed above, and have the right to transfer, convey and relinquish ownership of the pet to Lone Tree Animal Care. For valuable consideration, I hereby transfer all rights of ownership for the Pet listed above to Lone Tree Animal Care, the Pet Hospital of I understand that as the new owner of the Pet, Lone Tree Animal Care may provide the care and treatment it deems appropriate as its sole discretion. I understand that may include euthanasia as a human treatment option. If possible, Lone Tree Animal Care will attempt to facilitate the Pet's adoption to a caring home. At Lone Tree Animal Care's option, the Pet may be transferred to a local Humane Society or animal shelter to increase its exposure for adoption. I hereby release Lone Tree Animal Care from any and all claims that I have or may have related to the Pet. I understand and agree that Lone Tree Animal Care has no obligation to provide further medical treatment to the Pet or to further inform me of the continued health, treatment or placement of the pet. I agree to indemnify and hold harmless Lone Tree Animal Care and its employees, agents and staff member from any and all claims of any person claiming an ownership interest in the Pet, including reimbursing Lone Tree Animal Care for any costs or express of any kind, including attorney fees it incurs in responding to any such claims. I also acknowledge that I am still responsible for any outstanding financial obligations to Lone Tree Animal Care. However, I am under no obligation to any future care or treatment by Lone Tree Animal Care to the Pet. I HAVE FULLY READ THIS AGREEMENT, UNDERSTAND ITS TERMS, AND AGREE TO BOUND THEREBY. Client Printed Name Client Signature Reset signature Signature locked. Reset to sign again Driver's License# Chief of staff/ Hospital Printed Name Chief of Staff/ Hospital Director Signature Reset signature Signature locked. Reset to sign again