SURRENDER FORM

Full Name(s) - (if married, please add both names) *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

This Dog.... *

is good with small dogs.

is good with large dogs.

is NOT good with other dogs.

is friendly with males.

is friendly with females.

is friendly with kids.

is friendly with strangers.

has never been around kids.

is potty trained.

I am the legal owner of the dog described above. Checking below confirms that I hereby voluntarily relinquish all claims and ownership of said dog to the organization known as West Valley Animal Rescue. I further acknowledge understanding that the dog becomes the property of West Valley Animal Rescue, and that West Valley Animal Rescue will spay/neuter this dog, if intact, and will make every effort to place this dog in a new family setting. *

Yes, I understand and agree.

I agree that I have honestly answered all of the above questions, to the best of my knowledge, and have read and completely understand the above release. *

Yes, I agree.