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Surrender / Rehoming form

We know that rehoming can be a really tough decision. Thank you for taking the responsible step to find a safe, loving home instead of giving up. We’re here to support you.

Dog Information

Gender
Spayed / neutered?
Approximate age of dog
Do you currently have additional dogs which need placement?

IF YOU HAVE MULTIPLE DOGS WHICH NEED TO BE REHOMED, A SEPARATE FORM NEEDS TO BE PROVIDED FOR EACH DOG

Microchipped
Vaccination status
unknown
partially vaccinated
fully vaccinated
If partially vaccinated, please supply administered vaccines
DHPP
DHPP Booster
DHPP booster + rabies
Bordetella
Leptospirosis
Influenza for dogs
If dog has received care, where was it administered?
Has dog received flea / tick prevention treatment
Any known medical conditions?
Any current medications?
How did you acquire the dog?
What is your preferred method for pick up?

By signing below, I acknowledge and agree to the following:

  • Transfer of Ownership — I am the lawful owner of the dog and voluntarily and permanently surrender all ownership rights, claims, and interests. I understand this transfer is irrevocable and I may not reclaim the dog at any time.

  • No Continued Rights — I understand I will not receive updates, visitation, influence over placement, or any future decision‑making authority regarding the dog.

  • Truthfulness of Information — All information I have provided is complete and truthful to the best of my knowledge. I have not withheld or misrepresented any behavioral, medical, or situational details.

  • Full Disclosure of Behavior & Medical History — I have disclosed all known medical conditions, medications, behavioral concerns, bite history, aggression, and special needs.

  • Authority to Surrender — I confirm I am the legal owner and have full authority to surrender this dog. I am not violating any breeder contract, adoption agreement, co‑ownership, or legal restriction.

  • Rescue’s Right to Make All Decisions — I understand the rescue has sole discretion regarding the dog’s care, treatment, placement, training, or any other decisions made after surrender.

  • Rehoming Fee Clause — I understand the rescue may charge an adoption or rehoming fee to future adopters. I agree that I am not entitled to any portion of such fees, donations, or sponsorships, and that all funds are used at the rescue’s discretion for animal care and operations.

  • Financial Responsibility — I understand I will not receive compensation of any kind for surrendering the dog. I remain responsible for any outstanding veterinary bills incurred before surrender.

  • Liability Release — I release and hold harmless the rescue, its staff, volunteers, and affiliates from any liability, claims, or damages related to the dog after surrender.

  • Veterinary Records Release — I authorize the rescue to obtain veterinary records and verify the dog’s medical history with any veterinarian or clinic.

  • Permanent & Irrevocable Agreement — I understand this surrender is final, permanent, and legally binding.


By checking this box, I confirm that I have read and understand all terms listed above and agree that my surrender of this dog is permanent and irrevocable.
Agree
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