Toy Fox Terrier Rescue, Inc. (TFTR, Inc.)
Surrender/Release Agreement
Description of Owner:
Name:
Address:
Phone Number:
Email:
Description of Dog:
Call Name:
Registered Name/ AKC/UKC #:
Tattoo/Avid Chip #:
Sex:
Weight:
Spayed/Neutered: __Y _N
Approx. Age or DOB:
Coat Color:
White/Tan
Tail Docked:
Y
N
Tri-Colored
Chocolate
Black/Tan
Health and History Information:
Breeder’s Name (if known):
Breeder’s Address:
Vet’s Name:
Phone #:
Vet’s Address:
City:
State:
Zip:
Date of Current Shots:
Has Dog Ever Been Bred:
Y
N
Heartworm: Last Tested?
Results:
Negative
Positive
Heartworm Prevention:
Y
N Type:
Date of Last Pill:
Housetrained?
Y
N Crate Trained? Y
N Obedience Trained?
Y
N
Prefers
Men
Women
Either
Good with Children?
Babies/ Toddlers/ Teens
Cat Friendly?
Gets along with other dogs?
Big/Small/ Male/ Female
Special Tricks (fetch, rollover, soccer, etc.):
What is the dog’s diet (brand of food, how many times a day, etc.)?
List Negative Behavior (Destructive, Jumps Fences, Escape Artist, Digging, Food aggression,
etc.):
Revised August 6, 2013
Toy Fox Terrier Rescue, Inc.
Surrender/Release Agreement
Page Two
Has dog bitten a Human or Animal? If so, please give particulars (this is required):
Reasons for surrendering this dog:
Have you given this dog’s medical history to TFTR, Inc.?
And is there any other medical history that we should know about (eyes, hips, seizures, illness,
allergies, injuries, on medication, etc.)?
Agreement:
I hereby state that I am the sole owner/releaser of the above-described dog and that there are no
other parties that may have legal interest in this dog. I hereby surrender all of my interest and
ownership rights in such dog to TFTR, Inc. and hereby relinquish all claims to such dog. I
understand that such a surrender/release of my ownership rights in this dog is irrevocable. I state
and affirm that to the best of my knowledge, the said dog has not bitten any human being or
animal unless full disclosure is made above. I understand and agree that if I have not made full
disclosure about any known bites, I agree to indemnify and hold harmless TFTR, Inc. for any
damages resulting from the dog’s undisclosed propensity to bite. I understand and agree that I am
surrendering/releasing this dog to TFTR, Inc. of my free will and that such surrender/release does
not constitute a sale. I further understand and agree that I will receive no money or other
compensation as a result of surrendering this dog but that I have received a benefit from this
surrender in that I can no longer care for this dog. Should it become necessary for TFTR, Inc. to
take legal action to defend itself or otherwise enforce the provisions of this Agreement, the
Undersigned Releaser(s) agree to pay all court costs and attorney fees.
Such a release is executed this
day of
2
.
Signature of Owner/Releaser:
Print Name:
Revised August 6, 2013