Chihuahua Rescue & Transport
Release & Surrender for Adoption Form

TERMS OF RELEASE AND SURRENDER FOR ADOPTION

1. I/we the undersigned, hereby IRREVOCABLY surrender to CRT for placement and adoption, a Chihuahua described as follows:

Call Name:  __________________________________________________________

Sex: _____________        Color: ______________________    Age:______________

Date of Birth (if known):  ____________________

2. REPRESENTATIONS AND WARRANTIES – We hereby represent and warrant to CRT, their agents, successors, and assigns that the undersigned are the sole owner(s) of the above described Chihuahua.  That I/we have full power and authority to surrender this animal for adoption, that I/we are the only person(s) who are listed as registered owner(s) of this animal with the AKC, that no other person or persons' signatures are required to effect a valid transfer of AKC registration papers on this animal, and that no other person or persons have any legal or equitable ownership interest in this animal.

3. PERTINENT INFORMATION – We agree to provide CRT with any documents and all other available information concerning this Chihuahua which might assist in matching this Chihuahua with the proper prospective adoptive home, including health and shot records, pedigree, name and address of breeder or other person from whom the dog was acquired, and information concerning this Chihuahua’s history.

4. CONSENT FOR CONTACT – We understand that CRT may contact the breeder or previous owner of the Chihuahua to provide additional background information, or otherwise assist in locating a suitable adoptive home and hereby give our consent to these efforts. 

5. SURRENDER OF RIGHTS – By executing this document, we understand that we are giving up forever all right, title and interest to the above-mentioned Chihuahua and we further understand that all future decisions regarding placement of this animal will be made solely by CRT. We also understand that if this Chihuahua is later found to have such an unpredictable temperament as to be unsuitable for any placement, or if the animal’s quality of life is substantially impaired, in the opinion of a competent veterinarian, by a chronic, irreversible, painful condition, euthanasia may be considered as a final alternative to adoptive placement.

6. I/we undersigned, hereby specifically and forever release, and hold CRT harmless, from any and all liability arising from the placement for adoption by CRT, of the above-mentioned Chihuahua, or for any other actions taken by CRT in accordance with, and reliance on, the representations we have made, and the authorization we have provided under the terms of this document. We agree to indemnify and hold harmless CRT for any damages suffered and expenses incurred (including legal fees) in defending any legal action, whether for bodily injuries or death, property damage, breach of contract, or otherwise, whether instituted by us or by any other person or persons including the adoptive owners, arising out of or in consequence of the placement of the Chihuahua, in reliance on the authorizations, representations and warranties we have made in this agreement.

7. I/we certify that this dog is not possessed of any dangerous or vicious propensities, and that I/we have not willfully concealed information about the dog that might indicate such propensities.  This is a legally binding document for the irrevocable surrender of your Chihuahua for placement to an adoptive home. Please read carefully and completely before signing. Take as much time as you need to fully consider this important decision. 

8. We gladly welcome donations to offset the cost of transportation, medical, kenneling, food. 

     Donation amount: $ ___________

I have read the preceding and agree to the conditions set forth this _________ day of ____________, ________.

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Signature of owner

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Address

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City, State, Zip

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Phone

WITNESSED:

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Signature of Rescue Representative