Owner Surrender Agreement

If you need to rehome your dog, we accept dogs that are 25 lbs or less and good with dogs/cats/people. If your dog fits that criteria, please fill in and submit this form and follow the instructions at the bottom for sending us photographs.

Name of Owner *

Email *

Phone Number *Area Code - Phone Number

Address *

Street Address Line 2

City *

State/Province *

ZIP / Postal Code *

Country

Name and Sex of Dog *

Breed *

Color(s) *

Age and date of birth if known *

Microchip #

What is your reason for surrender?

Has your dog been altered (spayed or neutered)? If so, please describe.

Has your dog had any vaccinations, heartworm testing? If so, please describe.

Does your dog have any health issues? Are they allergic to anything?

Does the dog behave around kids? *YesNoDon't know

Does the dog get along with other dogs? *YesNoDon't know

Does the dog get along with cats? *YesNoDon't know

What do you feed your dog & how often?

Does your dog show any signs of food aggression? Are you able to remove a food bowl or a bone from your dog? Is your dog possessive over food or toys? Will your dog allow another dog near his/her food or toys?

Does your dog walk well on the lead or does he/she pull? How often were they walked?

Did your dog live indoors or outdoors? *

Is your dog house trained? *If yes, please spedify if pad or outdoor.

Is your dog house trained? *

How many hours a day is your dog used to being alone? *

Does your dog have separation anxiety? If so, what form does this take? Does your dog bark, or become destructive when left alone?

Any other comments?

Donation

When we take a dog in, we keep it in our home with our family and pets. Whether it takes weeks or months to find it a home, we keep the dog with us and incur the cost of it's care and vetting.

We are self funded and pay for our rescue work out of our adoption fees and donations, but this typically does not cover all of our expenses during the year.

When we take a dog in, we keep it in our home with our family and pets. Whether it takes weeks or months to find it a home, we keep the dog with us and incur the cost of it's care and vetting.

We are self funded and pay for our rescue work out of our adoption fees and donations, but this typically does not cover all of our expenses during the year.

WMH Owner Surrender Contract

I hereby certify that I, *Full Name

an adult, do hereby voluntarily and irrevocably give, donate, surrender, and release to Walk Me Home Rescue Group, hereinafter referred to as “WMH,” the subject of this Animal Surrender Form, hereinafter referred to collectively as “Animal.”

1. I represent and warrant that I am the lawful owner of the Animal, and I have full power and authority to surrender the Animal to WMH. No other person has any legal or equitable ownership interest in the Animal. *Initial

2. I have disclosed to WMH all material information regarding the medical and behavioral history of the Animal. I willfully surrender all medical records and information pertaining to the Animal. WMH has my permission to contact my veterinarian for any necessary information pertaining to my Animal, and I hereby consent to the release of any and all medical information by any medical provider. *Initial

Veterinarian's Name

Phone NumberArea Code - Phone Number

Address *

Street Address Line 2

City *

State/Province *

ZIP / Postal Code *

Country

3. I further acknowledge that I am releasing the Animal completely voluntarily and that no representations, considerations, or promises of any kind have been made to me by WMH or any of its representatives. *Initial

4. I understand that by releasing the Animal to WMH, I relinquish all ownership or other interest in the Animal. I will not seek further information about the Animal and will not press WMH for details. My contact with the animal terminates at the time of surrender. WMH is under no obligation whatsoever to follow up with information regarding the Animal. *Initial

5. I hereby release and forever discharge WMH from any and all rights, claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the Animal, and I agree to indemnify and hold WMH harmless from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties. *Initial

6. This is a legally binding document for the irrevocable surrender of the referenced Animal to WMH. *Initial

7. I have fully read and understand this Owner Surrender Agreement. I accept and agree to abide by its terms. *Please write your signature in the box

Are you able to foster your animal until Rescue can find a suitable home?YesNo

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Owner Surrender Agreement

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Adoption Stories

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