Surrender My Pet

Midland County Pit Stop Pet Surrender Agreement

* Indicates required field

Name *

First

Last

Email *

Comment *

Reason for Surrender *

Physical Address *

City *

State *

Zip Code *

Landline Number *

Cell Number *

I, _________________________________________________,, release ownership of my dog/dogs/cat/cats, to Midland County Pit Stop in Midland, MI (herein referred to as Midland County Pit Stop) as of (date) / / . The breed(s) description(s) of my pet(s) are as follows:

Name/Type/ Breed/Age
Name/Type/ Breed/Age
Name/Type/Breed/Age

In surrendering my pet(s) to Midland County Pit Stop, I am absolved of all liability, financial responsibility resulting from my pet's health, behavior, or training. In surrendering my pet(s) to Midland county Pit Stop, I forfeit the right to make decisions regarding my pet(s) private adoption, health, behavior and or trains as of the date lists above.

Intial Here *

If my pet(s) is/are determined to be too dangerous to rehome or becomes ill or injured to a level that is deemed life threatening by the vet that Midland County Pit Stop works with, Midland County Pit Stop reserves the right to make all decisions pertaining to my pet(s) treatment and adoption process.

Initial here *

Midland County Pit Stop does not buy or pay for pets. this service we provide to help place pets in new homes when their present owner can no longer care for or keep said animal. The service is free and a donation is appreciated to aid in the care of the pet until he/she is adopted.

Initial Here *

I hereby relinquish all rights to the above named pet/pets to Midland County Pit Stop. I hereby certify that I am the legal owner of the cat/dog. (licensing and vet documentation are required as proof of sole ownership or signature by a co-owner required). I hereby certify that this pet is not dangerous, vicious and has no bite record. I have not willfully concealed any information about the pet that might indicate such behaviors. I further understand and agree that I received no money or any other compensation as a result of this surrender, I hereby relinquish all claims to said pet and understand that this surrender is irrevocable and ownership of this pet is relinquished to Midland County Pit Stop. I understand that if I willingly lied or mislead any truths of said surrendered animal I could be held responsible for any legal ramifications.

Untitled *

Owner Signature *

Date *

Owner's Printed Name *

Co-Owner's Signature *

Date *

Co-Owner's Printed Name *

Midland County Pit Stop Representative *

Date *

Midland County Pit Stop Representative's Printed Name *

Please fill the portion out for any and all pets being surrendered to Midland County Pit Stop, Midland, MI

PET PROFILE

Pet's Name *

Gender *

Weight *

Breed *

Age *

Spray/Neutered? *

Microchipped? *

If so, Microchip Number *

Housebroken? *

Yes No

Crate Trained? *

Yes No

Socialized Regularly? *

Yes No

Health Concerns *

Feeding Instructions/Food/Allergies *

Favorite toy, game or treat *

Medications *

Has your pet every been aggressive or bitten anyone? *

Yes No

If yes, please explain *

When left alone does your pet bark/cry? *

Yes No

Chew? *

Yes No

Stratch at things? *

Yes No

Is this pet afraid of strangers? *

Yes No

being left alone? *

Yes No

Vet? *

Yes No

Children, dogs or cats? *

Children dogs cats

Loud noises? *

Yes No

Car rides? *

Yes No

Has this pet ever been cared for outside of your home, by a sitter, kennel or dog walker? *

Yes No

If so, please indicate name and contact number *

Does your pet walk respectfully at your side on a leash? *

Yes No

If no, what sets them off? *

What commands does your pet know? *

Please indicate any behavioral issues *

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Midland County Pit Stop Pet Surrender Agreement