Surrender Form

TERMS OF RELEASE AND SURRENDER FOR ADOPTION:

I/we, the undersigned, hereby IRREVOCABLY surrender to Belgian Sheepdog Rescue Trust for placement and adoption, a canine described as follows. YOU MUST BE THE LEGAL OWNER OF THIS DOG IN ORDER TO SURRENDER IT. IF YOU FIND A DOG, PLEASE REPORT IT TO THE LOCAL ANIMAL CONTROL AGENCY, WHERE IT CAN BE RECLAIMED BY THE RIGHTFUL OWNER.

REPRESENTATIONS & WARRANTIES – I/We hereby represent and warrant to Belgian Sheepdog Rescue Trust (BSDRT), their agents, successors and assigns that the undersigned are the sole owner(s) of the above described dog, that I/we have full power and authority to surrender this dog for adoption, that I/we are the only person(s) who are listed as registered owner(s) of this dog with the AKC (if applicable), and that no other person or persons have any legal or equitable ownership interest in this dog.

OTHER PERTINENT INFORMATION – I/We also agree to provide BSDRT with any documents and all other available information concerning this dog which might assist in matching this dog with the proper prospective adoptive home, including, but not limited to, health and shot records, pedigree, name and address of breeder or other person(s) from whom the dog was acquired, and information concerning this dog’s “history,” such as important life events and temperament matters.

SURRENDER OF RIGHTS – By executing this document, I/we understand that I/we are giving up forever all right, title and interest to the aforementioned dog and I/we further understand that all future decisions regarding the placement of this dog will be made solely by BSDRT. I/We also understand that if this dog is later found to have a temperament as to be unsuitable for any placement, or if the dog’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.

RELEASE AND INDEMNITY – I/we, the undersigned, hereby specifically and forever release, and hold Belgian Sheepdog Rescue Trust harmless, from any and all liability arising from the placement for adoption by BSDRT of the aforementioned dog, or for any other actions taken by BSDRT in accordance with, and in reliance on, the representations I/we have made, and the authorizations I/we have provided under the terms of this document. I/We agree to indemnify and hold harmless BSDRT 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 me/us or by any other person or persons including the adoptive owners, arising out of, or in consequence of, the placement of the aforementioned dog, in reliance on the authorizations, representations and warranties I/we have made in this agreement.

THIS IS A LEGALLY BINDING DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR DOG FOR PLACEMENT TO AN ADOPTIVE HOME WHEN THE SURRENDER IS APPROVED AND YOUR DOG IS ACCEPTED BY THE BELGIAN SHEEPDOG RESCUE TRUST. PLEASE READ CAREFULLY AND COMPLETELY BEFORE SIGNING. TAKE AS MUCH TIME AS YOU NEED TO FULLY CONSIDER THIS IMPORTANT DECISION.