Mastino Rescue, Inc. Owner Surrender and Release

I am the legal owner of this dog and I surrender all claim of ownership of this dog to Mastino Rescue, Inc. (MRI) without recourse. I understand that all possible attempts will be made to place the dog into a loving home as a pet where the dog will be well cared for. I also understand that the MRI Board of Directors will decide what action will be taken with the dog. *

Name of Dog:

*

Breed:

*

Age/Date of Birth:

*

Spayed/Neutered or Intact:

*

Spayed

Neutered

Intact

Color of Dog:

*

Black

Blue

Mahogany

Tawny

Weight of Dog:

*

Eye Color of Dog:

Ears of Dog:

*

Tail of Dog:

*

The dog described herein is the same dog in the Surrender Application was submitted to MRI on

(date of application)

The dog described herein is licensed this year and I am surrendering its license and rabies tags. *

The dog described herein is microchipped. *

Yes

No

I don't know

Microchip Number:

Dog Registration:

The dog described herein is registered with a national registry service (i.e., American Kennel Club, (AKC), APR, ACA, UKC, etc.) and I am surrendering.

I have never possessed registration papers of any kind on this dog and it is unregistered.

The dog herein is registered and I am surrendering ALL documentation with the dog.

I understand that Mastino Rescue, Inc., is a 501(c)(3) non-profit organization and I wish to help the organization defray expenses involved with medical and behavioral rehabilitation as well as food, travel and supplies for the dog. Therefore, I am making a donation in the amount of $(enter dollar amount) *

Method of payment will be

Paypal: mastinorescueinc@gmail.com

Venmo: @MastinoRescueInc

CashApp: $MastinoRescueInc

Facebook Donate: www.facebook.com/mastinorescueinc

Check/Money Order/Cashier's Check

Cash Upon Transferring Dog

I CERTIFY THAT ALL THE INFORMATION ON THIS FORM HEREIN AND THE SURRENDER APPLICATION THAT WAS SUBMITTED ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF.

By signing below, I agree to surrender all ownership and rights of the above described said dog to MRI. I also give permission to MRI to access all medical records of this dog. I certify that all information on this form and all attachments are true and correct. The undersigned hereby forever releases, discharges, covenants to hold harmless and indemnify for all costs to MRI or any official agents from any and all claims for damages, expenses or actions arising out of any act or occurrence pursuant to this Contract and/or conduct of said dog.

E-Signature *

Signature Date: *

Printed Name of Surrendering Owner: *

Street Address: *

City, State, Zip: *

Phone Number: *

Email: *