Animal Seizure/Surrender Form

  • Document No.

  • Officer

  • CRM created

  • CRM Number

CAMDEN COUNCIL Animal Seizure/Surrender Forms

Seizure/Surrender Information

  • CRM number

  • Officer

  • Officer Signature

  • Time and Date of Seizure/Surrender

  • Surrender or Seizure

  • Reason

  • Customer or Owner

  • Customer/Owner Details

  • Location/Address of Seizure/Surrender
  • Location where Animal was Found

  • Declaration

  • I surrender all my right title and interest in the animal to camden council and agree that it becomes the sole and absolute property of the council, who is authorised to HOLD, SELL or DESTROY it as the council or any member of the same in it's or their discretion deems fit.<br>I agree to indemnify council and keep the council indemnified against all claims (if any) costs, expenses whatsoever arising out of any action by any person claiming an interest contrary to that expressed in the declaration.

  • Signature of customer/owner

  • Photo of signed Seizure/Surrender Form at vets

Animal/Impound Information

Animal Information

  • Animal type

  • Breed

  • Sex

  • Age

  • Colour

  • Microchipped

  • Microchip number

  • Animal registered

  • Previous Impound History

  • Additional comments/Information

  • Picture of Animal

Transportation of Animal

  • Destination of animal

Impound information

  • Impound tag number

  • Release information

  • Name and signature of Pound officer

Microchip Information/Release Details

Microchip Details

  • Owner Details

  • Address

  • Contact number

  • Additional information

  • Has the owner been contacted

Release to Owner/Agent

  • Owner or Agent

  • Details match microchip details

  • New contact details (if they don't match microchip) eg address, contact numbers

  • Identification

  • Name & Signature of Owner or Agent

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