GRRAND Surrender Contract

GRRAND Owner Surrender Contract

Owner #1 Name(Required)

First Last

Owner #2 Name

First Last

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Dog #1 Name(Required)

Name

Dog #2 Name

Name

Has your dog(s) ever bitten a person?(Required)

Yes

Has your dog(s) ever bitten another animal?(Required)

Yes

If you answered "Yes" to either question above, please provide a detailed description of the event(s) and circumstances.

Describe here

Important Notice

Read the conditions below.  You will be required to consent to each in the signature field below.  All owners of the above-named dog(s) must sign this contract before Golden Retriever Rescue & Adoption of Needy Dogs, Inc. (hereinafter “GRRAND”) will agree to take this dog.

Regarding the surrender of the above-named dog(s), I/We, the undersigned, agree to the following conditions:

1. By signing this contract, I/We certify that I am the owner of this dog.
2. I/We understand that this dog becomes the responsibility of GRRAND and that I/We have no further rights to this dog.
3. All decisions regarding the placement of this dog will be made solely by GRRAND.
4. The undersigned has no right to information regarding the adoption of this dog.
5. I/We understand this contract and the policies described above and agree to their conditions.
6. I/We agree to hold GRRAND, its officers, board members, agents, and volunteers harmless for any loss of, damage to, or injury to persons, animals, or property arising from or relating to the placement of this dog.

Signature Authorization(Required)

By checking this box and typing your name below, you are signing this contract electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this contract.

I agree

I do not agree

Signature of Owner/Relinquisher #1

First Last

Date(Required)

Sigature of Owner/Relinquisher #2

First Last

Date

Signature of GRRAND Representative

First Last

Date

Authorization to Release Veterinary Records to GRRAND

Name of Veterinarian(Required)

Provide the name of your veterinarian. If you do not presently have a veterinarian and have never taken your pets to a veterinarian, please enter "NA."

Vet Name

Address

Street Address City State Zip

Veterinarian Phone Number(Required)

Pet Names and Breeds(Required)

Describe pets and breeds here. If you have not had pets in the past please enter NA.

Record(s) Recipient

Authorization to Release Veterinary Records

Signature for Authorization to Release Medical Records from Your Veterinarian(Required)

I agree

I do not agree

Whose name is on the vet account?(Required)

Pet Owner First Name Pet Owner Last Name

Date(Required)

Name

This field is for validation purposes and should be left unchanged.

GRRAND Surrender Contract