Owner Surrender Form

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Dog's name *

Dog's age *

Dog's breed *

Male/female *

Reason for surrender *

Spayed/neutered? *

Is the dog up to date on vaccines? *

Veterinarian name & number *

Is the dog good with other dogs? *

Is dog good with kids? *

This is a service to help place dogs/cats in new homes when their present owners can no longer keep them. Your donation will help pay for expenses. PLEASE READ, SIGN AND DATE THE FOLLOWING: I, , hereby surrender, the animal named , to TOLEDO'S PET BULL PROJECT. I certify that I am the owner of this dog, free and clear of all other interests. I certify that this dog is not possessed of any dangerous or vicious propensities, and that I have not willfully concealed information about the dog that might indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify TOLEDO'S PET BULL PROJECT, its board of directors, its members, officers, and agents from any and all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of the above named dog. *

Signature & date *