A.D.O.P.T. PET RESCUE RELEASE FORM

We, the undersigned, do hereby surrender to ______A.D.O.P.T. Pet Rescue______the dog(s) named ______, ______(description), for placement and adoption, with the following representations:

1) OWNERSHIP We hereby represent to ______A.D.O.P.T.______that the undersigned are the sole owner(s) of the above described dog and that we have full power and authority to surrender this animal for adoption, that we are the only person(s) who are owners of this dog and if an AKC registered animal, that we are listed as registered owners of the dog with the AKC (if registered), that no other person(s) signatures are required to effect a valid transfer of AKC registration papers on this dog, and that no other person(s) has any legal or equitable ownership interest in this animal.

2) DELIVERY OF REGISTRATION (if AKC registered) We hereby agree to deliver a properly signed transfer of the AKC registration papers for this dog to ______A.D.O.P.T.______at the execution of this document, omitting the name of the transferee. If we do not deliver AKC papers, we warrant that none exist.

3) OTHER PERTINENT INFORMATION We also agree to provide ______A.D.O.P.T.______with any documents and all other available information concerning this dog which might assist in finding an appropriate adoptive home. This includes health and "shot" records, pedigree and address of breeder, if applicable and/or person from whom the dog was acquired, and other information such as the dog's history.

4) CONSENT FOR CONTACT We hereby give consent to ______A.D.O.P.T.______for contacting the former owners, and/or breeder, if applicable and this dog's veterinarian for the purpose of obtaining additional background information, if necessary.

5) SURRENDER OF RIGHTS - By executing this document, we understand that we are giving up forever all right, title, and interest to the above dog and we further understand that all future decisions regarding the placement of this dog will be made by _____A.D.O.P.T.______.

We have carefully read and understand the conditions for the surrender of this dog and agree to the conditions set forth in this agreement.

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Signature of surrendering party/owner

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Address

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City, State, Zip

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Phone/E-mail