Massachusetts Dog Owner Surrender and Transfer of Ownership Agreement

Massachusetts Dog Owner Surrender and Transfer of Ownership Agreement

Please complete this mobile-friendly agreement to permanently surrender and transfer ownership of the dog to UnCommon Canine Academy (Bobbi-Jo Cefalo). Include all known medical, behavior, bite, and ownership details; unknown or none known may be selected where allowed.
Owner Information
Legal Name

First NameMiddle NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Dog Information
Dog Name
Breed / Mix
Age: Age years old or Date of Birth: Date of Birth
Sex
Spay / Neuter Status
Microchip Number
Microchip Registration Information
Color / Markings
Primary Veterinarian / Clinic
Are medical records provided?
Current Medications
Allergies
Known Medical Conditions
Vaccination Information
Rabies Information
Behavior and Safety
Describe any behavior issues observed
Has the dog ever bitten any person or animal?
Date of bite incident
Circumstances of the bite incident
Injuries or harm resulting from the bite
Reporting, quarantine, or official designation related to the bite
Is the dog aggressive or does it guard food, toys, people, or spaces?
Other safety concerns or risk factors
Ownership and Authority
Other prior owners or co-owners
Proof of ownership and authority to surrender

Cancelof
Outstanding ownership disputes
Consent, Declaration, and Signatures
I affirm this surrender is permanent, voluntary, and unconditional; it is not temporary boarding; ownership transfers upon my signing and physical handover of the dog
I understand there is no guarantee of adoption, no promise the dog will be kept, and no payment or charitable tax deduction will be provided
Owner declaration: I declare that, to the best of my knowledge, all known bite incidents, behavior history, and medical history have been truthfully disclosed, and I have lawful authority to transfer ownership with no known undisclosed competing claims
Legal statement: Bobbi-Jo Cefalo d/b/a UnCommon Canine Academy becomes the legal owner upon surrender and may keep, adopt out, transfer to a rescue or shelter, or arrange lawful humane veterinary care, including euthanasia when medically or behaviorally appropriate and legally allowed, with no obligation to return the dog or provide progress updates; I waive continued ownership subject to applicable Massachusetts law
Owner e-signature
Owner signature date and time

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
I understand that this is a permanent transfer of ownership with no guarantee of adoption and no payment or charitable tax deduction, and that Massachusetts General Laws Chapter 140 Sections 155 and 157 are referenced only as general context for dog-related liability and dangerous dog proceedings and do not themselves create a universal private surrender bite-disclosure obligation
Bobbi-Jo Cefalo or authorized representative signature
Physical custody handover date and time

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Should be Empty:

Massachusetts Dog Owner Surrender and Transfer of Ownership Agreement

Owner Information

Dog Information

Behavior and Safety

Ownership and Authority

Consent, Declaration, and Signatures