Release Form

Patchwork Rescue/Refuge

408 Paige Lane

Thomaston, GA 30286

706-647-1485

706-647-5755

RELEASE FORM

I hereby relinquish all rights to the following FID (feathered or furry kid):

Type of FID ______________________________________________________________________

Name of FID ______________________________________________________________________

Band# or Physical Identifying Feature: ____________________________________________________

___________________________________________________________________________________

Accessories: _______________________________________________________________________

___________________________________________________________________________________

Owner Signature: _____________________________________________________________________

Print Owner Name: ____________________________________________________________________

Rescuer SIgnature: _____________________________________________________________________

Print Rescuer Name: ____________________________________________________________________

Witness: ___________________________________________________________________________

Date: ______________________________________________________________________________