Release Form

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Release Form

ABOUT THE DOG
What is the dog's name?*
Male or Female?*
- Male
- Female
Colors?*
- Black & white
- Grey & white
- Red & white
- White
- Other
Please enter the approximate age of the dog.*
OWNER DECLARATION
By our signature(s), I/we (hereinafter "we") certify that we are the sole owners of this pet and hereby relinquish that ownership. Pet Harbor Rescue & Referral, Inc. (hereinafter “Pet Harbor”) accepts the pet into our rescue. We hereby state that we are the sole owners of the above-described dog and that there are no other parties that may have a legal interest in this dog. We hereby surrender all of our interests and ownership rights in such dog to Pet Harbor and hereby relinquish all claims to such dog. We understand that such surrender and release of our ownership rights in this dog are irrevocable. We state and affirm that, to the best of our knowledge, said dog has not bitten any human being or animal unless full disclosure has made to Pet Harbor. We understand and agree that if we have not made full disclosure about any known bites, we agree to hold Pet Harbor harmless and indemnify Pet Harbor for any damages resulting from the dog’s undisclosed propensity to bite. We understand and agree that we are surrendering this dog to Pet Harbor of our own free will and that such surrender and/or release does not constitute a sale. We further understand and agree that we will receive no money or other compensation as a result of surrendering this dog but that we have received a benefit from this surrender in that we have decided to no longer care for this dog. We further understand that Pet Harbor does not guarantee that the dog will be placed into another home. We further understand that Pet Harbor makes no guarantees of any kind to retain the dog's current medical status or given name. We further understand that this relinquishment is complete and Pet Harbor will not disclose to us any information about the pet’s well-being or disposition after this date. By our signature below, we certify that we are the legal owners of the dog and are acting in that capacity to release the dog’s legal ownership to Pet Harbor Rescue & Referral, Inc. By signing, we certify that the above written information is correct and signify an understanding of the above.*
- We consent to the above statement.
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I am the sole owner or co-owner of the above-specified dog and hereby release said ownership to Pet Harbor Rescue & Referral, Inc.*
Please type your full name below. This will be considered your signature.
Date*
MM slash DD slash YYYY
I am the co-owner of the above-specified dog and hereby release said ownership to Pet Harbor Rescue & Referral, Inc.
Please type your full name below. This will be considered your signature.
Date
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

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Release Form

ABOUT THE DOG

OWNER DECLARATION

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