I, ___________________________________, the legal owner of ___________________________________, surrender this animal(s) to Virginia Rabbit Inc. I understand that from this point forward I have given up all legal rights to this animal(s). I further understand that Virginia Rabbit Inc. will be making every effort possible to place this animal(s) in a new home. I further certify that I have listed below all the information I have on this animal(s).

Source Of Animal: ______________________________________
Known Medical Issues: __________________________________
Spayed or Neutered/Where: ______________________________
Last Vet. Visit / Where: __________________________________
Reason For Surrender: ___________________________________
Other Rabbit(s) Owned: _________________________________

______________________  Owner*

______________________ Virginia Rabbit Inc.

*By signature here I certify that I will not take any legal action against Virginia Rabbit Inc. and/or related companies or any staff members, for any reason, at anytime. I further note that I have been given no guarantees or verbal commitments in reference to this matter. If abuse is noticed on animals, VRI will report details to local authorities for enforcement at their discretion.