1. ROMP Italian Greyhound Rescue agrees to accept into the rescue program the dog(s) described below.
2. It is expressly understood by the parties of this Surrender Agreement that the Releaser voluntarily surrenders the below described dog(s) to the rescue service free and clear of any claim of ownership and guarantees that no claim of ownership will ever be made against said dog(s).
3. Releaser represents and warrants that the Releaser is the sole owner of this/these dog(s) and has the full and complete legal right to release said dog(s) to ROMP. Releaser will provide any registration papers or medical records upon release to ROMP. Releaser provides full disclosure of all known information regarding the temperament, behavior, characteristics and medical problems and treatments of the dog(s) below.
4. ROMP assumes all responsibility for the dog's/dogs’ actions after the dog is released. The rescue service agrees to hold releaser harmless for any actions of the dog(s) after it is released to the rescue service unless there is an undisclosed history of aggression or aggressive episodes involving biting. It is mutually agreed by the parties that the only exception shall be if the dog(s) remain(s) in the physical custody of releaser as set forth in paragraph 5.
5. If the dog(s) being released herein remain(s) in the physical custody of releaser until such time as ROMP finds a suitable home for the dog(s), it is understood and agreed that the dog(s) is/are the sole property of ROMP.
Name of Surrendered Dog*
Date of Birth
Name of Surrendered Dog (2nd dog)
Date of Birth (2nd dog)
Gender (2nd dog)
Breed (if other than IG / IG mix)
Where and when was this dog acquired?*
Reason for surrender*
Name and contact information for your veterinarian:
On preventative heartworm medication? If yes, which kind?
On flea/tick prevention?
If they are on flea/tick prevention, which kind?
Date of last rabies vaccine:
Date(s) of Distemper/Parvo/Parainfluenza vaccinations
Date of last Bordetella vaccination
Date & results of most recent fecal exam:
Allergies (food, medication, etc.)
History of Aggression?
Good with other dogs?
Good with cats?
Good with other pets (eg. birds, reptiles, hamsters, etc)? If so, please check which ones.
Good with children?
Does this dog exhibit behaviors that could lead to escape such as scaling fences, digging underneath fences, etc? Please explain.
Describe your dog’s personality, likes/dislikes, habits, etc.
Please provide any other information that you think would be helpful in evaluating / training this dog and identifying an appropriate adoptive home for him/her.
I hereby intend to relinquish all rights and responsibilities to the dog(s) described above to ROMP Italian Greyhound Rescue as of today's date,
I authorize the veterinarian(s) listed herein to release all medical records concerning this/these dog(s) to ROMP Italian Greyhound Rescue. By typing my name below, I also assert that I have read and understood this agreement and have answered the above questions fully and to the best of my knowledge.*
A representative from ROMP Italian Greyhound Rescue will be in touch shortly to assist you and your pet further. If you have any other questions, list them below.