ActNow Rescue

OWNER RELEASE AND SURRENDER FOR ADOPTION FORM


I/We, the UNDERSIGNED, hereby IRREVOCABLY surrender to Rescue for placement and adoption, the animal described as follows:

                                                                  

REPRESENTATIONS & WARRANTIES – I/We hereby represent and warrant to rescue, agents, successors and assigns that the undersigned are the sole owner(s) of the above described animal.  That I/We have full power and authority to surrender this animal for adoption, that I/We are the only person(s) who are listed as registered owner(s) of this animal with the American Kennel Club (AKC), that no other person or persons’ signatures are required to effect a valid transfer of AKC registration papers on this animal, and that no other person or persons have any legal or equitable ownership interest in this animal.

 

CONSENT FOR CONTACT – I/We understand that rescue may contact the veterinarian of the animal to provide additional background information or otherwise assist in locating a suitable adoptive home and hereby give our consent to these efforts.

 

SURRENDER OF RIGHTS – By executing this document, we understand that we are giving up forever all right, title and interest to the above-mentioned animal and we further understand that all future decisions regarding the placement of this animal will be made solely by rescue.  I/We also understand that if this animal is later found to have such an unpredictable temperament as to be unsuitable for any placement, or if the animals quality of life is substantially impaired, in the opinion of a competent veterinarian, by a chronic, irreversible, painful condition, euthanasia may be considered as a final alternative to adoptive placement.

 

RELEASE AND SURRENDER FOR ADOPTION

 

I/We have read the preceding and agree to the conditions set forth this 

 

 

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Signed by Michelle Losh
Signed On: January 2, 2019

Signature Certificate
Document name: OWNER RELEASE AND SURRENDER FOR ADOPTION FORM
Unique Document ID: af9d2cd96438c134c02caeadba26d2380763b8f8
TimestampAudit
December 28, 2018 7:41 AM CDTJan Siener - [email protected] added by Jan Siener - [email protected] as a CC'd Recipient Ip: 96.35.222.18
December 28, 2018 1:24 PM CDTOWNER RELEASE AND SURRENDER FOR ADOPTION FORM Uploaded by Jan Siener - [email protected] IP 75.130.214.48
January 2, 2019 4:32 PM CDTJan Siener - [email protected] added by Jan Siener - [email protected] as a CC'd Recipient Ip: 75.130.214.48
January 2, 2019 4:32 PM CDTJan Siener - [email protected] added by Jan Siener - [email protected] as a CC'd Recipient Ip: 75.130.214.48

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