FOR THE LOVE OF DANES RESCUE SOCIETY

Release and Surrender for Adoption

TERMS OF RELEASE AND SURRENDER FOR ADOPTION: toFor the Love of Danes Rescue Society

I/we, the undersigned, hereby IRREVOCABLY surrender to For the Love of Danes Rescue Society, its successors and assigns, for placement and adoption, a Great Dane described as follows:

Name: ______Microchip/Identification Number: ______

Sex: ______Color: ______Date of Birth/Approximate Age: ______

Reproductive Status:IntactEar Status: Natural

Surgically Altered Cropped

hereinafter referred to as the "Great Dane."

  1. Representations and Warranties:

I/We hereby represent and warrant to For the Love of Danes Rescue Society, its agents, successors and assigns that the undersigned are the sole owner(s) of the above described Great Dane. That I/we have full power and authority to surrender this animal for adoption, that I/we are the only person(s) who are listed as registered owner(s) of this animal with the CKC, that no other person or persons' signatures are required to effect a valid transfer of CKC registration papers on this animal, and that no other person or persons have any legal or equitable ownership interest in this animal.

  1. Delivery of Registration:

I/we agree to contemporaneously with the execution of this document deliver to For the Love of Danes Rescue Society, a properly signed transfer of the CKC registration papers for the above described Great Dane, omitting the name of the transferee. I/We hereby designate and authorize For the Love of Danes Rescue Society, as our agent and attorney-in-fact for purposes of designation a transferee and inserting this name on the CKC registration transfer form,

  1. Other Pertinent Information:

I/We also agree to provide For the Love of Danes Rescue Society, with any documents and all other available information concerning this Great Dane which might assist in matching this Great Dane with the proper prospective adoptive home, including health and shot records, pedigree, name and address of breeder or other person from whom the dog was acquired, and information concerning this Great Dane's "dog history," such as important life events and individual personality quirks.

  1. Medical Release:

By executing this document I/we hereby authorize the Doctor of Veterinary Medicine, above named, to disclose and/or release to For the Love of Danes Rescue Society, its agents, successors or assigns, either verbally or in writing, complete information concerning his or her medical findings, treatments and records about any animals for which I/we have sought care and/or treatment from the so named Doctor of Veterinary Medicine.

  1. Consent for Contact:

I/We understand that For the Love of Danes Rescue Society may contact the breeder or previous owner of the Great Dane to provide additional background information, or otherwise assist in locating a suitable adoptive home and hereby give our consent to these efforts.

  1. Surrender of Rights:

By executing this document, I/we understand that I/we are giving up forever all right, title and interest to the above-mentioned Great Dane and I/we further understand that all future decisions regarding the placement of this animal will be made solely by For the Love of Danes Rescue Society. I/We also understand that if this Great Dane is later found to have such an unpredictable temperament as to be unsuitable for any placement, or if the animal’s quality of life is substantially impaired, in the opinion of a competent veterinarian, by a chronic, irreversible, painful condition, euthanasia may be considered as a final alternative to adoptive placement.

  1. Release and Indemnity:

I/we, the undersigned, hereby specifically and forever release, and hold For the Love of Danes Rescue Society, harmless, from any and all liability arising from the placement for adoption by For the Love of Danes Rescue Society, of the abovementioned Great Dane, or for any other actions taken by For the Love of Danes Rescue Society, in accordance with, and in reliance on, the representations I/we have made, and the authorizations I/we have provided under the terms of this document. I/We agree to indemnify and hold harmless For the Love of Danes Rescue Society, for any damages suffered and expenses incurred (including legal fees) in defending any legal action, whether for bodily injuries or death, property damage, breach of contract, or otherwise, whether instituted by me/us or by any other person or persons including the adoptive owners, arising out of or in consequence of the placement of the Great Dane in reliance on the authorizations, representations and warranties I/we have made in this agreement.

  1. Certification:

I/we hereby certify that this Great Dane is not possessed of any dangerous or vicious propensities, and that I/we have not willfully concealed information about the Great Dane that might indicate such propensities. The information I/we have provided about this Great Dane is true and complete.

THIS IS A LEGALLY BINDING DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR GREAT DANE BEFORE PLACEMENT TO AN ADOPTIVE HOME, PLEASE READ CAREFULLY AND COMPLETELY BEFORE SIGNING. TAKE AS MUCH TIME AS YOU NEED TO FULLY CONSIDER THIS IMPORTANT DECISION.

It is understood that For the Love of Danes Rescue Society, does not buy or pay for Great Danes. This is a service to help place Great Danes in new homes when their present owners can no longer keep them.

I/we have read the preceding and agree to the conditions set forth this ____ of ______, 20___.

Owner’sFull Name: ______

Address: ______

City:______Province: ______Postal Code:______

Home Phone:______Work Phone:______

Signature of Owner ______

Signature of Co-Owner ______

Signature of For the Love of Danes Rescue Society

______

Authorized Representative

Release and Surrender for Adoption FormPage 1 of 2