Owner Release Form

Owner Release Form

In order to find the most appropriate home for your dog, please provide as much detail as possible about his/her history, veterinary care, likes and dislikes, and behaviors. By providing this information you are ensuring the easiest transition for your pet, only you know them best. Behavior and medical issues do not necessarily create problems but not disclosing them certainly will. Please be truthful about your dog's situation so we can try to provide the best resources to them. If you are surrendering more than one dog, please fill out a separate form for each one.
I agree with, and understand, the above statement *

Yes No

Section One - Owner's General Information
Owner's Name *

First Name Last Name
Owner's Email *
example@example.com
Owner's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Owner's Home Phone Number *

Area Code Phone Number
Owner's Mobile Phone Number *

Area Code Phone Number
Where did you adopt/purchase the dog from and have you contacted them directly first? *

Section Two - Dog's General Information
Dog's Name / Nicknames *
Dog's DOB / Approximate Age *
Dog's Breed or Best Guess *
Dog's Weight *
Dog's Color and Markings *
Gender *

Unaltered Male Unaltered Female Neutered Male Spayed Female
Upload Photo of Dog *

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Section Three - Dog's History
Explain why you are surrendering this dog *
If we could help you resolve this issue, would you be interested in keeping this dog? *
How long have you owned this dog? *
What do you know of the dog's history prior to your ownership? *

Section Seven - Signature
As of today's date, I certify that I am over 18 years of age. *

Yes No
I certify that I am the lawful owner of this dog that I am surrendering

Yes No
I certify by selecting yes that I fully understand and accept the terms and conditions of the Lola's Rescue Owner Surrender Agreement below

Yes No
LOLA'S RESCUE, INC. OWNER SURRENDER AGREEMENT

It is understood that Lola's Rescue does not buy or pay for dogs. This is a service to help place dogs in new homes when their present owners can no longer keep them. This service is free, however a donation to help pay for expenses is greatly appreciated as we are a nonprofit rescue and rely heavily on our donors to continue saving the lives of the dogs that come into our care. Any amount, small or large, is helpful and can be made on our website or via check sent to 22351 East Bayaud Avenue, Aurora, Colorado 80018.
READ, ACCEPT AND DATE THE FOLLOWING:

I hereby make available for adoption, the dog named below on this form, to Lola's Rescue. 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 herby forever release, discharge and agree to hold harmless and indemnify the Lola's Rescue, 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 named dog.
Print the name of the dog you are surrendering *
Owner Surrender Full Name as legal signature

Clear
Should be Empty:

Owner Release Form

LOLA'S RESCUE, INC. OWNER SURRENDER AGREEMENT

READ, ACCEPT AND DATE THE FOLLOWING: