6443 Oak Canyon
Irvine, CA 92618
I am the owner, or owner's agent, of the animal described on this form. To the best of my knowledge, this animal (check one below)
I request that the Irvine Animal Care Center (IACC) accept this animal and understand it may be euthanized for the reason(s) noted below. The IACC reserves the right to determine the animal's disposition, which may include euthanasia or adoption.
Please check all that apply.
I release the City of Irvine and the Irvine Animal Care Center, their officers, employees, agents, and volunteers from any and all claims, liabilities, expenses, or judgments arising from the acceptance, euthanasia, and/or other disposition of this animal. I delcare under the penalty of perjury that the foregoing is true and correct to the best of my knowledge.
The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject-matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, all information provided on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, businesses or individuals.