Dog/Puppy Surrender Form

Touching Hearts Animal Rescue

Surrender Form- Dog
Date

MonthDayYear
Date
OWNER DETAILS
Name
Address
Phone
Email
example@example.com
DOGS DETAILS
Dogs Name
Gender
Approximate age or DOB
Breed
Colour
Dogs age when he/she arrived into your home
Where did you get the dog (breeder, RSPCA, giveaway etc)
ANIMALS HEALTH HISTORY
Is the dog desexed
Is the dog up to date with vaccinations
Is the dog microchipped
Please provide microchip number
Has the dog had any previous health concerns
Does the dog have any current health concerns
DOGS PERSONALITY & BEHAVIOUR
Is the dog good with cats (please elaborate)
Is the dog good with other dogs (please elaborate)
Is the dog good with children
Is the dog an escape artist (jumps fences, digs under fences etc)
Has the dog ever bitten a person or harmed another animal
Is there anything else you would like us to know about the dog
What is your reasoning for wanting to surrender the dog
By Signing this document, you agree that

-All information provided in this document is true, complete, and correct as at the date of submission. You confirm that you have not knowingly withheld, misrepresented, or provided any false or misleading information in relation to the animal.
-Upon acceptance of this Surrender Form by Touching Hearts Animal Rescue Inc., you agree to transfer full legal ownership of the animal to Touching Hearts Animal Rescue Inc. If the animal is microchipped, a microchip ownership transfer form will be provided to you electronically and must be completed without delay. Ownership of the animal is deemed transferred to Touching Hearts Animal Rescue Inc. upon completion of the microchip transfer form, or upon acceptance of this Surrender Form where no microchip exists.
-Upon acceptance of this Surrender Form, you agree to immediately pay a non-refundable surrender fee to Touching Hearts Animal Rescue Inc. as follows:

$100 for undesexed dogs; or
$75 for desexed dogs or dogs under six (6) months of age.

-You acknowledge and agree that surrendering the animal does not grant you any preferential right or entitlement to re-adopt the animal. Should you wish to apply to adopt this animal, or any other animal in the care of Touching Hearts Animal Rescue Inc. at any time in the future, you must submit an adoption application and comply with all standard adoption procedures, requirements, assessments, and approval criteria applicable to all applicants. Touching Hearts Animal Rescue Inc. retains absolute discretion in relation to adoption decisions, and no guarantee or priority of adoption is given or implied.
SIGNATURE
Signature
Date

MonthDayYear
Date
Should be Empty:

Touching Hearts Animal Rescue

OWNER DETAILS

DOGS DETAILS

ANIMALS HEALTH HISTORY

DOGS PERSONALITY & BEHAVIOUR

SIGNATURE