EmailMeForm
Lancaster Four Dog Rescue Surrender Agreement
I hereby agree to surrender the animal listed below to Lancaster Four Dog Rescue, INC.
Species (Dog, Cat, etc):
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Animals name
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Breed or unknown:
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Sex
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Please select
Female
Male
Spayed/Neutered or Intact:
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Microchip#
Description: Color/Markings
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Legal Owners Name
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Address
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Phone
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Email
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Please describe the circumstances of why you need to surrender this dog to Lancaster Four Dog Rescue
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Is this dog good with children?
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Please select
Yes - good with all kids
Good only older kids
No - Not good with any kids
Unknown
Has the dog ever bitten or nipped anyone? *** If dog bit or nipped please describe circumstances in detail (if not, state N/A)
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Is the dog good with other dogs (small, big? Please describe how the dog interacts) (if not known state unknown)
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Is the dog good with cats?
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Please select
Yes
No
Unknown
Is the dog Housetrained?
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Please select
Yes
No
Working on it
Unknown
On Date typed below: The above named animal is hereby surrendered and all rights of ownership/responsibility are transferred to Lancaster Four Dog Rescue. Transferor is released of any and all liability associated with named animal. Transferor gives freely permission to Lancaster Four Dog Rescue to keep or adopt the animal to a new family or transfer animal to another with all rights included.
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BY TYPING MY NAME BELOW I AUTHORIZE THAT ALL OF THE INFORMATION I HAVE PROVIDED ON THIS APPLICATION IS, TO THE BEST OF MY KNOWLEDGE, TRUE AND COMPLETE AND I HAVE THE RIGHT TO SURRENDER THIS ANIMAL.
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