Owner Surrender Request
Contact Information

*

*

*

*

*

*
 - 

*


*

*


x

*



*=required

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*


*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

*

By signing and submitting this form, I/we relinquish all rights of ownership of the Brittany listed above, to National Brittany Rescue & Adoption Network, Inc., (NBRAN), and do hereby certify to the best of our knowledge, that this dog has never bitten anyone. 

Further, it is understood that NBRAN was contacted with the express purpose of releasing our rights of ownership.  NBRAN agrees to accept responsibility for the care of said dog until such time as s/he is placed in an appropriate, loving home with approved adopters.  It is also explicitly understood that if, on the advice of NBRAN’s veterinarian, said dog cannot be rehabilitated to a state of good health then s/he may be humanely euthanized at the sole discretion of NBRAN. 

I/we also certify that the following information provided is as accurate and true as possible. 

 

*

*=required