Surrenderform



			NORTH FLORIDA GREAT DANE RESCUE GROUP
	Main Page Contact Us Available Danes Adoption Process Adoption Application Surrender a Dane Surrender Form Breed Information Health Information Donations/Wish List Rescue Groups Links

			Helping one dane at a time. Contact us at [email protected] or (904) 813 - 6709


	OWNER�S RELEASE INTERVIEW AND AGREEMENT Date:__________ Breed:_______________ Sex: M / F Altered: Y / N AKC # ______________________ Color:____________ Ears: ____________ Microchip or Tatoo # ___________ Dog�s name: ______________________ Age:________ Dog�s registered name: __________________________________________________________ Owner�s Name: _____________________________ Phone # _____________________ Owners Address: _______________________________________________________________ Reason for Surrender: ___________________________________________________________ ______________________________________________________________________________ Housetrained: Y / N Crate Trained: Y / N Leash Trained: Y / N Barks: Y / N Digs: Y / N Dog Aggressive: Y / N Jumps Fence: Y / N Obedience Trained: Y / N Date of last shots: ____________________ Date of last worming: ______________________ Date of last heartworm test: ______________ Date of last vet visit: _________________ Date of last heartworm preventative: ______________________ Type:_________________ Current Medications: ____________________________________________________________ Other medical problems: _________________________________________________________ Type of food: ____________________________Feedings per day: AM___PM____Both ______ Previous owner/breeder _______________________________________Phone ______________ Veterinarian ___________________________________________ Phone _________________ Does dog: sleep in house: Y / N sleep on bed or furniture: Y/N do tricks(list commands on back of form): Y / N Get along with men: Y / N Get along with women: Y / N Get along with children: Y/N Get along with strangers: Y/N Get along with cats: Y/N Get along with other animals: Y / N Chew on furniture: Y / N Chew in general: Y/N Ride well in car: Y / N Has this dog ever attacked another animal? Attempted to bite? Has your dog ever bitten a person? Attempted to bite? It is understood that NFGDRG does not buy or pay for dogs. This is a service to help place Great Danes in new homes when their present owners can no longer keep them. This service is free, HOWEVER, a donation of $75 or more to help pay for dogs expenses is requested, expected, and appreciated !! Please read, sign and date the following: I, __________________________________, hereby make available for adoption, the Great Dane, named ________________________, to NFGDRG. I certify that I am the owner of this dog, free and clear of all other interests. I certify that this dog is not possessed of any dangerous or vicious propensities, and that I have not willfully concealed information about the dog that might indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify the NFGDRG, its board of directors, its members, officers, and agents from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of the above named dog. Owners name: __________________________________ Date: _______________ I also agree my name and phone number may be released to the new owner of this dog. And that the new owner may contact me if he/she wishes, to gain any further information on this dog. Signed by owner: ________________________________________ Date:_____________ North Florida Great Dane Rescue Group Release and Surrender for Adoption TERMS OF RELEASE AND SURRENDER FOR ADOPTION: 1. I/we, the undersigned, hereby IRREVOCABLY surrender to the NFGDRG for placement and adoption, a Great Dane described as follows: Call Name: _________________________ Sex: ______ Color: ____________ Age: ______ AKC Registered Name: __________________________________________________________ AKC # : ___________________________ 2. REPRESENTATIONS & WARRANTIES - We hereby represent warrant to North Florida Great Dane Rescue Group, their agents, successors and assigns that the undersigned are the sole owner (s) of the above described Great Dane. 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, and 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. 3. DELIVERY OF REGISTRATION - I/we agree to (contemporaneously with the execution of this document) deliver to NFGDRG a properly signed transfer of the AKC registration papers for the above described Great Dane (within 3 days), omitting the name of the transferee. We hereby designate and authorize NFGDRG as our agent and attorney-in-fact for purposes of designation a transferee and inserting this name on the AKC registration transfer form. 4. OTHER PERTINENT INFORMATION - We also agree to provide NFGDRG with any documents and all other available information concerning this Great Dane which might assist in matching this Great Dane 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 Great Dane�s �dog history,� such as important life events and individual personality quirks. 5. CONSENT FOR CONTACT - We understand that NFGDRG may contact the breeder or previous owner of the Great Dane to provide additional background information, or otherwise assist in locating a suitable adoptive home and hereby give our consent to these efforts. 6. SURRENDER OF RIGHTS - By executing this document, we understand that we are giving up forever all right, title and interest to the above mentioned Great Dane and we further understand that all future decisions regarding the placement of this animal will be made solely by NFGDRG. We also understand that if this Great Dane is later found to have such an unpredictable temperament as to be unsuitable for any placement, or if the animal�s 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. 7. RELEASE AND INDEMNITY - I/we, the undersigned, hereby specifically and forever release, and hold NFGDRG harmless, from any and all liability arising from the placement of adoption by NFGDRG of the above mentioned Great Dane, or for any other actions taken by NFGDRG in accordance with, and in reliance on, the representation we have made, and the authorizations we have provided under the terms of this document. We agree to indemnify and hold harmless 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 Great Dane, 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 GREAT DANE 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 CALL (904) 813-6709. I have read the preceding and agree to the conditions set forth this _________day of __________, 2______. _____________________________________ _____________________________ Signature of Owner Phone _____________________________________________________________________________ Address City State Zip Witnessed: ________________________________________________________ All Content provided by North Florida Great Dane Rescue Group

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