I have read and agree to all of the following:

1. I certify that I am 18+ years old.

2. I certify that all information I have given on this form are true and correct.

3. I understand that relinquishment fees will be due when I bring my animal in. Relinquishment fees are non-refundable.

4. I understand that should my animal not be suitable for the adoption program, WVHS staff may call me to give me the option to reclaim my animal.

5. I understand that WVHS is happy to provide additional resources and advice to help me keep my pet.

6. I understand that I am relinquishing ownership of my animal to West Valley Humane Society. I no longer will have the right to own my animal, make medical decisions, or choose placement.

7. I understand that if I opt to participate in the Adopt From Home Program, I have relinquished ownership.

8. I understand that WVHS can only provide medical care for the pet based on resources and diagnostic capabilities available to them. If my animal has previously diagnosed medical conditions, I will be responsible for providing medication until my pet is adopted.

9. I agree to indemnify and hold harmless West Valley Humane Society, the attending veterinary, veterinary technician, any other WVHS employees and/or volunteers from any and all liability arising from the shelter taking ownership of my pet.