Pet Dog Surrender Form

Pet Dog Surrender Form

Please complete this form to record the surrender a Dog or Puppy
Full Name

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Dog/Puppy Name
Dog/Puppy Age (in months/years)
Microchip number
Breed
Date of Surrender

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for Surrender
Is the dog spayed or neutered?
Vaccination status

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Veterinary records available from your vet?
Any Health conditions or medications
Terms and conditions
Terms and Conditions
The Dog/Puppy is surrendered voluntarily and no money will be returned unless previously agreed on in writing. All control including Pedigree, Microchip and any other documentation will be returned to the Breeder to be used at their discretion. We will not refund any moneys under any circumstances if: 1. The owner has been informed by Xioma Kennels in writing of any potential genetic disease and it can be shown that the owner has responded acknowledging this. 2. The Owner has rehomed the dog themselves and not contacted Xioma Kennels and the new owner believes they are owed a refund. 3. The Owner no longer wants the dog and there is no medical reason. We will always take our dogs back under the above conditions.Terms and conditions
Signature
Should be Empty: