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RELEASE AND SURRENDER FOR ADOPTION

(page 1 of 2)

TERMS OF RELEASE AND SURRENDER FOR ADOPTION:

1. I/we, the undersigned, hereby IRREVOCABLY surrender to the (your rescue groups name) Rescue for placement and adoption, a (your breeds name) described as follows:


CALL NAME:________________________________  SEX:_______  COLOR:_______  AGE:_________

AKC REGISTERED NAME:______________________________________  AKC #:_________________

2. REPRESENTATIONS & WARRANTIES - We hereby represent and warrant to (rescue name) Rescue, their agents, successors and assigns that the undersigned are the sole owner(s) of the above described (your breed). 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 AKC, the no other person or persons' signatures are required to effect a valid transfer of AKC registration papers on this animal, and that no other person or persons have any legal or equitable ownership interest in this animal

3. DELIVERY OF REGISTRATION - I/we agree to (contemporaneously with the execution of this document) (within three days) deliver to (rescue name) Rescue a properly signed transfer of the AKC registration papers for the above described (breed name), omitting the name of the transferee. We hereby designate and authorize (rescue name) Rescue as our agent and attorney-in-fact for purposes of designation a transferee and inserting this name on the AKC registration transfer form.

4. OTHER PERTINENT INFORMATION - We also agree to provide (rescue name) Rescue with any documents and all other available information concerning this (breed name) which might assist in matching this (breed name) 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 (breed name)'s "dog history," such as important life events and individual personality quirks.

5. CONSENT FOR CONTACT - We understand that (rescue name) Rescue may contact the breeder or previous owner of the (breed name) to provide additional background information, or otherwise assist in locating a suitable adoptive home and hereby give our consent to these efforts.

6. SURRENDER OF RIGHTS - By executing this document, we understand that we are giving up forever all right, title and interest to the above-mentioned (breed name) and we further understand that all future decisions regarding the placement of this animal will be made solely be (rescue name) Rescue. We also understand that if this (breed name) is later found to have such an unpredictable temperament as to be unsuitable for any placement, or if the animals 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.

7. RELEASE AND INDEMNITY - I/we, the undersigned, hereby specifically and forever release, and hold (rescue name) Rescue harmless, from any and all liability arising from the placement for adoption by (rescue name) Rescue of the above-mentioned (breed name), or for any other actions taken by (rescue name) Rescue in accordance with, and in reliance on, the representations we have made, and the authorizations we have provided under the terms of this document. We agree to indemnify and hold harmless (rescue name) Rescue 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 us or by any other person or persons including the adoptive owners, arising out of or in consequence of the placement of the (breed name), in reliance on the authorizations, representations and warranties we have made in this agreement.

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RELEASE AND SURRENDER FOR ADOPTION

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THIS IS A LEGALLY BINDING DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR (breed name) FOR 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. IF YOU HAVE ANY QUESTIONS, PLEASE CALL: 000-000-0000.

I have read the preceding and agree to the conditions set forth this______ day of__________, 199____.


__________________________________________________

SIGNATURE OF OWNER

__________________________________________________

SIGNATURE OF CO-OWNER

__________________________________________________

ADDRESS

__________________________________________________

CITY, STATE, ZIP

__________________________________________________

PHONE

Witnessed:

__________________________________________________

RESCUE MEMBER