Surrender Agreement

RELEASE AND SURRENDER FOR ADOPTION
TERMS OF RELEASE AND SURRENDER FOR ADOPTION:

1. I/we, the undersigned, hereby IRREVOCABLY surrender to the Cocker Spaniel Rescue of the Mid Plains/ WiggleButtExpress
for placement and adoption, a Cocker Spaniel described as follows:

CALL NAME:
SEX:
COLOR:
AGE:
AKC REGISTERED NAME:
AKC #:

REPRESENTATIONS & WARRANTIES

We hereby represent and warrant to CSRMP/WiggleButtExpress Cocker Rescue,
their agents, successors and assigns that the undersigned are the sole owner(s) of the above described Cocker Spaniel.
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 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.

DELIVERY OF REGISTRATION

I/we agree to deliver to CSRMP/WiggleButtExpress Cocker Rescue
a properly signed transfer of the AKC registration papers for the above described Cocker Spaniel,
omitting the name of the transferee.
We hereby designate and authorize CSRMP/WiggleButtExpress Cocker Rescue as our agent
and attorney-in-fact for purposes of designation a transferee and inserting
this name on the AKC registration transfer form.

OTHER PERTINENT INFORMATION

We also agree to provide CSRMP/WiggleButtExpress Cocker Rescue
with any documents and all other available information concerning this Cocker Spaniel
which might assist in matching this Cocker Spaniel with the proper prospective adoptive home,
including health and shot records, pedigree,
name and address of breeder or other person from whom the dog was acquired,
and information concerning this Cocker Spaniel's "dog history,"
such as important life events and individual personality quirks.

CONSENT FOR CONTACT

We understand that CSRMP/WiggleButtExpress Cocker Rescue may contact the breeder
or previous owner of the Cocker Spaniel 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 Cocker Spaniel
and we further understand that all future decisions regarding the placement
of this animal will be made solely by CSRMP/WiggleButtExpress Cocker Rescue or it's designate.
We also understand that if this Cocker Spaniel 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 INDEMNITY

I/we, the undersigned, hereby specifically and forever release,
and hold CSRMP/WiggleButtExpress Cocker Rescue, it's members or designate harmless,
from any and all liability arising from the placement for adoption
by CSRMP/ WiggleButtExpress Cocker Rescue of the above-mentioned Cocker Spaniel,
or for any other actions taken by CSRMP/ WiggleButtExpress Cocker Rescue
in accordance with, and in reliance on, the representations we have made,
and the authorizations we have provided under the terms of this document.
We agree to indemnify and hold harmless CSRMP/WiggleButtExpress Cocker Rescue
for any damages suffered and expenses incurred (including legal fees)
in defending any legal action, whether for bodily injuries or death, property damage,
breach of contract, or otherwise, whether instituted by us or by any other person
or persons including the adoptive owners, arising out of or in consequence
of the placement of the Cocker Spaniel, in reliance on the authorizations,
representations and warranties we have made in this agreement.

THIS IS A LEGALLY BINDING DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR COCKER SPANIEL FOR PLACEMENT TO AN ADOPTIVE HOME.
PLEASE READ CAREFULLY AND COMPLETELY BEFORE SIGNING.
TAKE AS MUCH TIME AS YOU NEED TO FULLY CONSIDER THIS IMPORTANT DECISION.
IF YOU HAVE ANY QUESTIONS, PLEASE NOTIFY US.

Phone#
Phone #

or contact us at our website:
http://www.oocities.org/Petsburgh/Haven/9862

I have read the preceding and agree to the conditions set forth this______ day of__________, 199____.

__________________________________________________
SIGNATURE OF OWNER

__________________________________________________
SIGNATURE OF CO-OWNER

ADDRESS:

CITY, STATE, ZIP:

PHONE:

Witnessed:
__________________________________________________
RESCUE MEMBER

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