Surrender Form

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Surrender Form

* Fields are required

Subject *
E-mail *
Volunteer's First Name
Last Name
Date of Birth	MM/DD/YYYY
Address 1
Address 2
City
State/Province
Phone	###-###-####
Driver's License #
Dog's Name
Age
Sex
Breed
Color
Spay/Neuter	Yes No Unknown
Would you like to receive newsletters and future updates from the rescue?	Yes No
Consent	I am the owner of this animal or the owner’s representative acting upon the owner’s consent.
Consent	I understand that if I attempt to reclaim this dog in the future, I will be required to go through the standard adoption procedure and pay the adoption fee.
Consent	Welcome Home Rescue cannot guarantee adoption or placement of any dogs. If it is discovered that health, age, or behavioral problems are present after surrender or our veterinarian or members discover them upon examination or evaluation; the dog may also be humanely euthanized if appropriate housing and care are not available at sole discretion of Welcome Home Dog Rescue, its veterinarians, officers and directors.
Consent	I understand that whether or not this dog is made available for adoption is at the discretion of Welcome Home Dog Rescue and that Welcome Home Dog Rescue, its officers, directors and volunteers reserve the right to not answer questions you may have in the future regarding the disposition of this dog.
Consent	My signature below reflects that I read and understand the above information and that I am releasing all rights and claims for this dog to Welcome Home Dog Rescue.
Digital Signature	Type your full name
Date	MM/DD/YYYY
Question and Comment *