SURRENDER A GOLDEN

Your Name *

First Name

Last Name

Street Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

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Relinquish Ownership *

Being the above stated owner or possessor of the above stated animal, for good and valuable consideration, the receipt of which is hereby acknowledged, I/We hereby relinquish any claim of ownership and all rights to this animal to the Golden Retriever Rescue of Michigan (GRRoM) that I/We may have and warrant that to the best of my/our knowledge and belief, complete and undivided ownership of this animal shall be that of GRRoM.

I relinquish my ownership of the above state dog to GRRoM.

I do not relinquish my ownership.

Possession *

Once the dog is in GRRoM's possession, I/We cannot reclaim or adopt this dog.

I understand.

I do not agree to this.

Confirmation of Ownership *

I/We certify that, to the best of my/our knowledge and belief, this dog is NOT STOLEN.

This dog is not stolen.

I am unsure.

Historical Data Confirmation *

I/We certify that both in speaking to GRRoM and on this form, our description of the dog we are surrendering to GRRoM has been truthful and honest. Any history of aggression such as growling, snarling, snapping, nipping, bites to people or other animals, behavioral conditions such as anxiety or fearfulness, or chronic medical conditions, have been disclosed to GRRoM.

I have been truthful in my description of the dog I am surrendering.

I have more information I need to disclose.

Understanding of GRRoM Ownership *

I/We understand that as consideration for this transfer of ownership, GRRoM shall attempt to find this dog a suitable home. If this dog is found to be suffering from an incurable disease or demonstrates snapping, biting or aggression towards adults, children, or other pets, GRRoM will seek a medical evaluation and follow the prescribed medical treatment and/or advice.

I understand

I do not agree

Health and Temperament Disclosure *

I/We are disclosing everything we know regarding the health and temperament of this dog on this Owner Release Form. If I/We are found to have concealed any pertinent information previously known to us, I/We understand that we will be responsible for expenses incurred related to those conditions.

I understand and agree

I do not understand and/or agree

Understanding of Surrender *

I/We have read, and I/We understand the conditions outlined above and shall agree and consent by my/our typed names within this form below. I/We understand that the surrender of this dog is permanent and that I/We are relinquishing all rights of ownership, including the right to reclaim the dog.

I understand

I do not understand