OWNERSHIP RELEASE
This agreement sets forth the terms governing the transfer of ownership of the following dog, cat or other domestic animal (the “Pet”) by the undersigned (the “Owner”) to Weare Animal Guardians, Inc. (W.A.G.), (“WAG”), a non-profit animal adoption organization.
Owner Information: Description of Pet placed:
Name: ______Dog:____ Cat:____ Other:______
Address: ______Name: ______
City: ______Age:______Sex:____ Spayed/Neutered:____
State: ____ Zip:______Breed:______
Phone: ______Coloring:______
Markings:______
Medical (Vaccinations):______
In consideration for the acceptance of the Pet by WAG, receipt of which is hereby acknowledged, the Owner, hereby agrees to and acknowledges the terms of this agreement and further represents, warrants and covenants to WAG the following:
1. Current Ownership. The Owner is the current legal owner of the Pet and that there are no other persons who may claim ownership of the Pet.
The owner acquired the pet on______.
DD/MM/YYYY
2. Health of Pet.
(a) Except as set forth below, the Pet is in good medical health, has no known health problems, and does not require any prescription or non prescription medicine for maintenance of its health.
List exceptions and medications here: ______
______
(b) The Pet o has or o has not received at least annual veterinary care from a licensed veterinarian. List name and address of Veterinarian:
______
______
3. Behavior and Temperament of Pet. Except as listed below, the Pet has exhibited no behavioral tendencies (e.g.; aggression toward other domestic animals or humans, biting, fear of humans, etc.) that might require cautionary measures be taken by those WAG members or other persons charged with the Pet’s care.
List exceptions here: ______
______
4. Placement of the Pet.
(a) Understanding. The Owner understands that WAG will attempt to find a good home for the Pet consistent with the objectives and policies of WAG.
(b) Foster Care. The Owner agrees that WAG has the right to place the animal in foster care pending adoption.
5. Fees Non-refundable. The Owner hereby agrees and acknowledges that any fee which may have been paid to WAG in connection with WAG’s acceptance of the Pet pursuant to this Agreement is not refundable.
Fees are as follows: Dogs: $100.00 (one hundred dollars)
Cats: $25.00 (twenty-five dollars)
6. Release of Liability. The Owner hereby agrees to waive any claims, complaints, or causes of action whatsoever, whether in law or equity, against WAG, its directors, officers, members, and any other of its agents and hereby agrees to indemnify and hold harmless WAG for any loss, damage or injury or expense arising in any manner including but not limited to any such action or claim arising from this agreement, the actions of the Pet or any prospective owner, any loss, damage or injury to third parties, or property owned by third parties, including any expenses or liability incurred in defending any action by third parties. This release and indemnification shall apply to the Owner, its heirs executors, beneficiaries or assigns.
7. Transfer of Ownership. I hereby transfer ownership of the Pet to Weare Animal Guardians.
The undersigned Owner(s) have read and understood the above provisions and do hereby agree to all provisions as evidenced by there signatures:
Owner(s) ______Date:______
______Date:______
Weare Animal Guardians, Inc. (WAG)
WAG Rep :______Date:______
Owner Release form Page 1
Revised 10/04