A surrender fee/donation is required. For dogs under 3 years, the fee is $250, for dogs between 3-7 the fee is $350 and the fee for dogs over the age of 7 is $450. This surrender fee may be waived if the dog is up to date on vaccinations, is spayed/neutered and on heart worm medication (proof of vaccination and spay certificate is required). By dating and typing my initials in the space below I certify that I am the owner of, or have authority to surrender to Shiba Rescue of New Jersey, the animal described above. If SRNJ accepts the dog into rescue, the undersigned relinquishes all rights of ownership and any right to information on the disposition of said animal. I also authorize the release of any veterinary records regarding the animal. I certify that to the best of my knowledge I have disclosed all information about the animal concerning health, behavior, history and anything else that may affect the safe placement of the animal in a new home, and that all statements made above are true and correct. *