First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone*

Cell Phone*

Alt Email*

Date:

MUST ANSWER ALL OF THESE! Name of animal: Breed: Color: Age:*

This dog was acquired from: *

Provide details explaining why you are requesting to surrender the dog. Being too vague will result in delay or denial.*

Are the dog's vaccinations current? If so, do you have documentation?*

Is your dog neutered or spayed?*

Is dog an 1. Indoor dog? 2. Outdoor dog? 3. Indoor/Outdoor. If outdoor, please explain.*

What is dog's current environment. i.e. Lives with dogs, cats, kids, *

Has dog previously lived with cats or been around cats? If so, explain dog's reaction and behavior around cats.*

Is the dog kennel trained?

Is the dog suffering from any illness or injury? If so what?*

I understand and agree that: 1] Any dog(s) cared for by the Requestor is the sole property of the requestor. 2]The Requestor is responsible for all veterinary attention, medication, surgery, or euthanization of the dog(s) 3] If Requestor is no longer able to care for the dog(s), or no longer wants to care for the dog(s), he or she must place the dog(s) with another Rescue or other resource. 4] The SASPCA's role is limited to providing two venues for Requestor to market his/her dog(s): the SA Great Dane Rescue Website (www.texasgreatdane.org) and access to SASPCA,s weekly adoption event, in which Requestor must remain with the dog(s) at all times. 5] Exceptional customer service is required when communicating with potential adopters and applicants. This includes, but not limited to, response to inquiries within two days (emails and applications) and courteous assistance to inquiries at adoption events. I understand that if I want to adopt the dog(s) outside of the resources provided by the Rescue, I will owe a fee for resources used, any medical procedures paid for by the rescue, and any vaccinations provided by the Rescue. The fee to by paid to the Rescue will be no more than $250.00 I understand that SASPCA is not responsible for any injuries to anyone; even if occurrence is located at the SASPCA adoption event. I will be responsible for any medical and legal costs associated with an injury incident. I have read and understand the terms of this agreement and will abide by all the conditions stipulated. ELECTRONIC SIGNATURE: DATE: *

The adoption fee will be set using SASPCA fees. 100% of the adoption fee goes to SASPCA. *