Owner Surrender

We, (Please enter your full legal name)

Are surrendering our dog(s) Separate each dog with a comma

Age/Date of Birth: Separate each dog birthday with a comma

To The Animal Debt Project, Inc. We understand that our dog(s) will now become the property of The Animal Debt Project, Inc. and will be placed in a new home.

Our dog(s) IS

SpayedNeuteredNot

Our dog(s) are up to date on vaccines as required by The Animal Debt Project. Vaccines required are: Rabies, DHLPP (Distemper, Parvo, Lepto) and Bordetella.

Is VacinatedNot Vaccinated

Our dog(s) HAVE been heartworm tested and are negative.

Tested for HeartwormsNot Tested for Heartworms

Our dog(s) are on Heartworm Prevention and Flea/Tick Prevention.

Heartworm & Flea/Ticket PreventionNo Heartworm or Fleat/Ticket Prevention

We understand a surrender fee of $100 per dog IF NOT VETTED AND UP TO DATE is required. If dog(s) have been spayed/neutered, up to date on all vaccines and heartworm negative, NO surrender fee is required. OWNER MUST PROVIDE PROOF OF ALL VETTING. We have NOT been advised that our dog(s) have any serious or terminal health issures.

I agree

We are surrendering our dog due to: (please be indepth with your response here so we can better help this animal)

Date:

Your Signature