SWGDR
Dog/Puppy Surrender Agreement
Instructions:
Please read this agreement, fill in the blanks, electronically sign and submit to SWGDR (referred to as the "Charity/we/us"). Please DO NOT omit any information about your dog in order for us to get a home for him/her. This information is vital so we can find a suitable match for your dog's disposition, age and health.
The Agreement
In consideration of the mutual promises contained in this Agreement, and other good and valuable consideration, intending to be legally bound, Charity and the undersigned ("you") agree as follows:
1. Permanent Surrender. You are permanently surrendering to us the dog/puppy described as:
Name of the dog:
Age:
Spayed/Neutered:
Breed/Mix:
Eye Color:
Coloring:
Distinguishing characteristics:
You agree that you, your spouse and/or co-owners, if any, are irrevocably transferring and relinquishing to us legal ownership of the dog/puppy on the date of surrender. This gives us complete authority to take whatever actions in our sole judgement are necessary and in the best interest of the dog/puppy.
We suggest a $ 25.00 non-refundable surrender fee. Donations in addition to this fee are welcome.
2. Pet Information: You are providing the following information about the dog/puppy, which you promise is true, complete and correct on the date of this Agreement.
General Information
Are you the first owner?
If you are not the first owner, do you know what happened with the prior adoption?
Name and address of the prior owner:
Was your dog purchased from a breeder?
Breeder's Name:
Did you call the breeder for help finding a home?
Breeder's response to your call:
Do you have AKC papers?
Was your dog purchased from:
If other, please explain:
Why are you giving up the dog/puppy?
How long did you own the dog/puppy?
Did you try to find a new home on your own?
Health Information
Spayed/Neutered
Date:
Veterinarian's Name:
Veterinarian's Phone:
Physical Problems:
Allergies:
Please explain what kind of Allergies:
Last De-worming Date:
Rabies vaccination date:
Distemper vaccination date:
Name of Heartworm preventative:
Date last given:
Brand(s) of food dog eats:
Daily amount of food consumed:
You agree to direct your veterinarian to release the veterinary records for he dog/puppy to us?
Behavior Information
Is the dog good with children?
Is the dog good with cats?
Housebroken?
Any bad habits?
Explain bad habits?
Tell us if this dog:
Most appealing traits:
List skills, commands, tricks:
Dog spends the day (check all that apply):
Does the dog sleep with you at night?
What are the dogs favorite games:
Has this dog ever bitten anyone?
Was medical attention required for the bite?
3. Sterilization. If the dog has not been sterilized, you agree it must be spayed or neutered by us or you before it can be placed into a new home. We do not place mature dogs in new homes until they are sterilized. If possible, please make an additional payment to us in surrender of the dog/puppy towards the veterinary charges for sterilization. In the alternative, we suggest that you have the dog/puppy sterilized prior to surrender and provide written proof to us.
4. Strays. For a stray or undomesticated dog/puppy, you are providing the following additional information, which you promise is true and correct on the date of this Agreement:
Where the dog was found:
When the dog was found:
Did the dog live in or around your home, garage or elsewhere?
Is there any information about who might own the dog?
If yes to the above, please explain:
Is there any evidence that the dog/puppy is suffering from any bites, wounds or other injuries?
If injuries, bites or wounds please explain:
Does the dog growl or bare teeth?
Does the dog attack or bite?
5. No Guaranties. We will foster the dog/puppy while we try to find a good home for it. We make no representations or guaranties about our arrangements for the dog/puppy.
6. No Liability. We are not liable to you for any losses, injuries, damages, costs, expenses or liabilities whatsoever stained or incurred by you in connection with your surrender of the dog/puppy, and our subsequent adoption, foster or other arrangements for the dog/puppy.
7. Entire Agreement; Modifications; Binding Effect. This written Agreement contains the sole and entire agreement between the Charity and you, and supersedes as other agreements between you and us with the respect to the subject matter of this Agreement. No modifications of this Agreement will be valid unless in writing duly signed by both you and us. This Agreement will be binding on our and your respective heirs, personal representatives, executors, successors and assigns.
Date:
OWNER
Type OWNER'S name to serve as signature:
Type co-OWNERS name to serve as signature:
Please re-enter your E-mail :
Address:
City:
State:
Phone #:
Zip:
Owner's Name:
E-mail :
To surrender your Dane please fill out the information below and submit electronically. We will contact you once your Agreement has been received.
Southwest Great Dane Rescue, Inc.
is registered with the Florida Department of Consumer Services to solicit contributions.
Registration Number: CH25130
“A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.”
