EmailMe Form - Owner Surrender

Name of Dog *

Breed of Dog *

Age and Weight of Dog *

Is the Dog Fixed *

Owner's Name *

First Last

Owner's Address *

Street Address City State / Province / Region Postal / Zip Code

Home Telephone

### - ### - ####

Mobile Telephone *

### - ### - ####

Email *

Microchip Manufacturer and Number

Health and Medical Issues/ Treatment
Vaccinates, Rabies and Dates vaccinated *

Existing Diet and Feeding Schedule

Temperament of dog, Behavioral issues:
Has the dog attacked another dog?
Is the dog house trained? *

Why are you surrendering your dog? Does the dog have medical issues? *

Owner Surrender
The Dog must be current on vaccinations and medical records must be provided to validate. The rescue will need proof of spay/neuter at time of relinquishment. *

Yes, I have medical paperwork

No, I do not have medical paperwork

File Upload Photos/ Medical History

Are you willing to make a donation for the care of your dog? Donation amount? For non sterilized dog, a minimum donation of $100. *

Please Read The Following Carefully:

I declare that the information I have provided in this application is complete and correct. It is understood that Saving K9 Lives Plus Inc is providing a “service” to assist in helping place pets in new homes.

I/We hereby relinquish ownership of my dog to Saving K9 Lives Plus Inc.

I confirm that I am the owner of this dog and have not concealed any information about this dog. I hereby forever release, discharge and agree to hold harmless and indemnify Saving K9 Lives Plus Inc., from all claims, demands, actions, causes or action, or liability of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of this dog.

This is a binding contract and I understand it will hold up in the court of law that I have surrendered my dog *

I agree

I disagree

Signature *

Clear

Do you agree to these terms and conditions? *

Yes, I agree