My signature below certifies that I am the owner of, or have the authority to surrender to The Senior Dog Sanctuary of MD the animal described above. I certify that to the best of my knowledge I have disclosed all information about the animal concerning health, behavior, history, and anything else that may affect the safe placement of the animal in a new home and that all statements made above are true and correct. I understand once my dog is accepted, the Senior Dog Sanctuary of MD shall have sole and exclusive legal rights to make all outcome decisions deemed appropriate and that SDS shall not communicate the outcome of the animal to me or any other party.