For the Sake of Dogs

Surrender Contract

For the Sake of Dogs Fresno, CA Tel: (559) 275-3769;

Surrender Contract.doc (12/10)

For the Sake of Dogs Golden Retriever Rescue & Sanctuary, Inc.

Adoption Application, continued

Name(s) Relinquisher(s): ______

Street Address:______

City/State/ZIP:______

Telephone:[Home]______[[Work] ______

[Fax]______[Email] ______

Name of Dog:______Microchip#______

Age: ______Color: ______Weight: ______Sex: [ ] Male [ ] Female Altered? [ ] Yes [ ] No

Rabies Date: ______DHLPP Date: ______Bordatella Date: ______Heartworm Preventive Date: ______Flea Preventive Date: ______

IMPORTANT NOTICE: All owners of the above-described dog must sign this contract before For the Sake of Dogs will agree to take this dog.

In regard to the adoption of the above-described dog from For the Sake of Dogs), I/We, the undersigned, agree to the following conditions:

(1)By signing this contract, I certify that I am the sole owner of this dog. (If there are co-owners, all co-owners must also sign this contract before For the Sake of Dogs will accept this dog.)

(2)By signing this contract, I understand that this dog becomes the property of For the Sake of Dogs and that I have no further rights to this dog.

(3)For the Sake of Dogs will be solely responsible for the placement of this dog. All decisions regarding the placement of this dog will be made by For the Sake of Dogs. For the Sake of Dogs may consider, but has no obligation to use, referrals from the Relinquisher.

(4)The Relinquisher has no rights to information regarding the adoption or whereabouts of this dog. Any information or contact with the adopting party will be at the discretion and initiation of the adopting party.

(5)The Relinquisher gives For the Sake of Dogs authorization to obtain this dog’s health records from any veterinarian or clinic.

Veterinarian: ______Clinic: ______

Address: ______Telephone: ______

(6)The Relinquisher guarantees to For the Sake of Dogs that this dog’s history with regard to biting is accurately described as follows:

To my knowledge, this dog:[ ] Has[ ] Has Not bitten anyone.

[ ] Has[ ] Has Not bitten another animal.

If “Has” is noted, please describe the circumstances: ______

______

(7)Current health problems:______

(8)Does your dog…YesNoIs your dog…YesNo

Like to ride in cars______Afraid of storms______Where does your dog sleep at night?

Like to swim______Good with children______

Jump fences______Good with cats______Where does you dog stay during the day?

Walk well on leash______Good with other dogs______

Let you take toys/food away______House broken______Does your dog eat A.M. _____ P.M. _____

Have separation anxiety______Used to being groomed______What brand of food: ______

Come when called______Crate trained______Does your dog know any of the following commands:

Growl at strangers______Obedience trained______Sit _____ Down _____ Stay _____ Fetch _____

(9)Why are you surrendering this dog? ______

If the dog you are surrendering is not current on vaccinations or has not been spayed/neutered, we would welcome any contributions toward the cost of providing this veterinary care. Recommended donation for vaccinations due: $50.00 Recommended donation for spay/neuter due: $50.00

I/We understand this contract and the policies described above, and agree to their conditions. I/We agree to hold For the Sake of Dogs ., 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.

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Signatureof Owner/ RelinquisherDate

______$______

Signature Co-OwnerSurrender Donation Receipt Requested ( )

______

Signature of For the Sake of Dogs . AgentDate

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