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Owner Surrender and Release

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.


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