MMFM Rescue / Shelter To Rescue Transfer Form

Date of Transfer*

Date

Dog's Name*

Shelter ID # ( If applies )

Breed of Dog*

Sex of Dog*

Neutered / Spayed / Intact*

Microchip #*

Color / Markings of Dog*

Any / All Vet Care provided to dog. Explain Fully ( Paperwork will be required )*

Approximate Weight Of Dog*

Heartworm Status*

Dog / People / Child / Cat Agressive? If so explain fully *

Reason for Transfer*

The above named dog is hereby surrendered to Moving Mountains For Mastiffs and all rights of ownership & responsibility are transferred to Moving Mountains For Mastiffs. Transferor is released of any and all liability associated with the above named dog. Transferor gives freely permission to transferee to keep, adopt to new family, or transfer dog to another with all rights included.

Transferor Rescue / Shelter Name*

Transferor Director of Rescue / Shelter Full Name*

First NameLast Name

Transferor Rescue / Shelter Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Transferor Rescue / Shelter Phone Number*

Area CodePhone Number

Transferor Rescue / Shelter Email Address*

example@example.com

I certify that the information provided on this form is true & correct. I understand that an physical evaluation of the dog by an experienced rescue volunteer / member will be required before we accept surrender. If upon inspection we find that information contained in this surrender form to be false, we retain the right to turn down acceptance of the surrender at anytime during the evaluation.

Transferor Rescue / Shelter Signature*

Transferor Date Of E Signature*

Transferee Information:

Director: Monica Mayo Farmer

Moving Mountains For Mastiffs Rescue

4671 Old Madisonville Rd

Hopkinsville , KY 42240

(414) 573-1847

(270) 608-2944 TEXT ONLY

movingmountainsformastiffs@gmail.com

Arbitration. All claims and disputes arising under or relating to this Agreement are to be settled by binding arbitration in the state of Kentucky or another location mutually agreeable to the parties. This arbitration shall be conducted on a confidential basis pursuant to the Commercial Arbitration Rules of a American Arbitration Association. Any decision or award as a result of any such arbitration proceeding shall be in writing and shall provide an explanation for all conclusions of law and fact and shall include the assessment of cost, expenses., and reasonable attorney’s fees. Any such arbitration shall be conducted by an arbitrator experienced in rescue litigation and shall include a written record of the arbitration hearing. The parties reserve the right to object to any individual who shall be employed by or affiliated with a competing organization or entity. An award of arbitration may be confirmed in a court of competent jurisdictions.

MMFM Rescue / Shelter To Rescue Form