Owner Surrender Agreement

The services of Havanese Rescue Inc include the placement of Havanese in new homes when their present owners can no longer keep them. This service is free, however a donation to help pay for expenses is always appreciated. I hereby certify that I am the owner of the Havanese dog named
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free and clear of all other interests. I agree to surrender the dog to Havanese Rescue Inc and to relinquish all ownership rights, veterinary and health records if available, and any additional information concerning the dog. It is my understanding that Havanese Rescue Inc will do what is best for this dog.

With this instrument the dog becomes the property of Havanese Rescue Inc. The information I have provided about this dog is true and complete.

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certify that this animal is not vicious and has never shown signs of aggression toward human beings or other animals. (Explain on back) 
*** If I fail to disclose any previous aggressive behavior (such as attempts to bite, even if no contact was made), I agree to reimburse Havanese Rescue Inc for all costs and liability it may incur because of the dog's subsequent aggressive behavior.*** I am surrendering this dog to Havanese Rescue Inc with the understanding that the organization will attempt to find the animal a suitable home. Havanese Rescue Inc and its officers will not be held responsible for the actions of the adoptive or foster families and/or the dog. If Havanese Rescue Inc deems this dog to be unsuitable for adoption due to unacceptable temperament or other reasons, I understand that Havanese Rescue Inc reserves the right to euthanize the dog.
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request that should the organization decide to euthanize the dog, and every effort be made to contact me to offer the alternative of returning of the dog.
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This Contract is governed by the Laws of the State of Delaware.
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(Optional release) I agree that my name and phone number may be released to the new owner of this dog and that the new owner may contact me if they wish to gain any further information about this dog.
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Your dog will have the best chance of being placed in a suitable new home if we have the following information:
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Where does the dog spend the day?

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Where does the dog sleep?

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If dog has training what commands do they know?

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Includes bathing, combing, brushing, eye/ear cleaning and nail trimming.

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Does the dog growl or bite when picked up?

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Veterinarian Information
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Does the dog have, or has it ever had:
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LEAVING HOME Leaving your home will be traumatic for your Havanese. Because of this, when the time comes for your dog to leave your home, please bring things that will help it feel more comfortable during the transition to a new environment. Items you could bring with your Havanese include its toys, collars, leashes, remaining food, bedding, blankets, crate and anything else that is used by this dog. Registration papers, all medications and medical files are also requested. Your dog and its new owner will appreciate this. ADDITIONAL COMMENTS Please feel free to give any additional information you believe will aid in making this move easier for your dog. The more we know the easier it will be for all parties. Thank you for your cooperation. Add additional comments below if you need more space.
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© 2004 Havanese Rescue Inc., www.havaneserescue.com Use of this form by other rescue/animal assistance groups is permitted, however, this
contact/copyright information must remain on the form.

Changing lives ... one Havanese at a time.