The Underdog Railroad Canada
Paws on the Green Canada
SURRENDER/RELEASE FORM
PHONE: 905-471-8876
EMAIL: pogcanada@gmail.com
Name of Animal:
DOB or Approximate Age:
Species
[
] Feline
[
] Canine
[
] Other ______________________
Sex
[
[
] Female
] Intact
[
[
] Male
] Altered
[
] Undetermined
Breed
Color
Weight
Reason for Surrender:
Medical Profile
VACCINATIONS:
Date Administered:
FVRCP Vaccination
Calici Vaccination
FeLV/FIV test Results:
Negative: [
]
Positive: [
]
]
Positive: [
]
DA2PP Vaccination
Bordatella Vaccination (Intranasal)
Heartworm Test
Negative: [
Rabies Vaccination
I hereby certify that I am the sole owner/guardian of the above-mentioned animal and hereby relinquish
all rights, titles, and interests to this animal. The final disposition of said animal(s) is to be determined by The
Underdog Railroad Canada. I certify that all available information pertaining to the animal(s) has been reported
truthfully and accurately. I understand that there is a surrender fee of $75.00, which is due at the time the animal
is surrendered. I also understand that this fee must be paid in cash and is non-refundable.
Released by:
Released to:
Name: ____________________________
______________________
Phone
Address: ___________________________________________________________
(include City/Prov/Postal Code)
__________________________________
Signature
_______________________
Date
__________________________________
UDR/Signature
$75 Fee Received:_______
__________________________________
Print Name
_______________________
Date
Surrender/Release Contract
Paws on the Green, Inc.