Owner Surrender Form

Lone Star Boxer Rescue P.O. Box 541286
Houston, Texas 77254-1286
281.251.6179 Fax

Transfer of Ownership/Stray Release

Dog’s Name: ___________________

I, ____________________________________ (Surrenderer’s Name), being the sole owner of _________________(dog’s name) a ______________(dog’s age) (Sex-Circle One) M F, hereby forever relinquish all claims to and ownership of said animal to the organization known as “Lone Star Boxer Rescue” hereinafter referred to as “LSBR”. I understand that I cannot reclaim this dog once the dog is in the possession of LSBR. It is my intent to surrender to LSBR all of my ownership rights and all other interests of any kind pertaining to the dog. I understand that the final decision as to any adoption belongs to LSBR. I agree to give LSBR the dog’s AKC registration papers, if any, and all medical records available. LSBR shall attempt to find the dog a suitable home, but the organization shall not be held responsible for the actions of the adoptive or foster family.

I understand and agree to the above conditions.

Signature: Date:

Please print the following:

Name: Phone #:

Address:

Email Address:

Amount of donation collected: $

Minimum amount required : $50.00

LSBR Representative:

Lone Star Boxer Rescue P.O. Box 541286 Houston, TX 77254-1286 Phone: 713.464.1381 Fax: 281.251.6179