FOAC Surrender Agreement
Email address *
I/we, the undersigned, have made the decision to surrender the following named animal and have chosen to enlist the adoption services of Friends of the Animal Community of Sonora (herein referred to as rescuer), who will find a new home as appropriate. Please Initial. *
Your answer
Animal Name *
Your answer
Age *
Your answer
Birthdate *
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Weight *
Your answer
Male or Female *
Altered *
Microchip *
Microchip Number
Your answer
Vet Records *
Family *
Breed
Your answer
Canine Vaccines: DLPP Date
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YYYY
Canine Vaccines: Rabies Date
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YYYY
Canine Vaccines: Bordatella Date
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Feline Vaccines: FVRCP Date
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YYYY
Feline Vaccines: FELV Date
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Color/Unusual markings
Your answer
Health Restrictions
Comments on Health *
Your answer
House Trained
Obedience Trained *
Energy Level *
Personality and Behavior Qualities *
Good with Cats *
Good with Dogs *
Good with Kids *
Comments or more information *
Your answer
Reason for Surrender *
Your answer
1. I understand that the above named animal is being surrendered for its continued welfare and that rescuer accepts the animal in an AS IS condition. Please Initial. *
Your answer
2. Rescuer guarantees to the surrendering party that the animal will receive the utmost in care and consideration in the placement with a new owner and that future contact with the new owner will be done in the interest of continued health and welfare concerns. Rescuer operates as a service to animals and as such is not a business. Please initial. *
Your answer
3. I/we hereby represent and warrant to rescuer, their agents, successors, and assigns that the undersigned are/is the sole owner(s) of the above-described animal. Please Initial. *
Your answer
4. REGISTRATION. 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 CKC/AKC, that no other person or persons signatures are required to effect a valid transfer of CKC/AKC registration papers on this animal, and that no other person or persons have any legal or equitable ownership interest in this animal. Please Initial. *
Your answer
5. PERTINENT INFORMATION. I/we agree to provide rescuer with any documents, registration papers and all other available information concerning this animal which might assist in matching this animal with the proper prospective adoptive home, including health and inoculation records, pedigree, name and address of breeder or other person from whom the animal was acquired, and information concerning this animal's history. Please Initial. *
Your answer
6. CONSENT FOR CONTACT. I/we understand that rescuer may contact the breeder or previous owner of the animal to provide additional background information or otherwise assist in locating a suitable adoptive home and hereby give our consent to these efforts. I also grant my permission for all prior veterinary records and known medical history to be submitted to rescuer. Please Initial. *
Your answer
7. SURRENDER OF RIGHTS. By executing this document, I/we understand that I/we are giving up forever all rights, title and interest to the above-mentioned animal and I/we further understand that solely rescuer will make all future decisions regarding placement of this animal. I/we also understand that if this animal 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 finanl alternative to adoptive placement. Please Initial. *
Your answer
8. I/we, the undersigned, hereby specifically and forever release and hold rescuer harmless from any and all liability arising from the placement for adoption by rescuer of the above-mentioned animal or for any other actions taken by rescuer in accordance with and reliance upon the representations and warranties I/we have made herein and the authorization I/we have provided under the terms of this document. I/we agree to indemnify and hold harmless rescuer for any and all damages suffered and expenses incurred (including legal fees) in defending any legal action, 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 animal, in reliance upon the authorizations, representations and warranties I/we have made in this agreement. Please Initial. *
Your answer
9. I/we certify that this animal is not possessed of any dangerous or vicious propensities and that I/we have not willfully or knowingly concealed any information about the animal that might indicate such propensities. Please Initial. *
I/we have read the preceding and agree to the conditions set forth herein. Today's Date. *
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Full Name *
Your answer
Address *
Your answer
City, State, Zip *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Work Phone *
Your answer
FOAC Agent Name
Your answer
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