MIDLAND COUNTY PIT STOP
Home
About
Adopt Me!
K-9
Feline
Forms
Donations
The Plan
Contact
CommUnity
Event Calendar
I Want to Adopt
I Want to Foster
Surrender My Pet
Find a Foster for My Pet
I Want to Help!
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
*
Submit
Home
About
Adopt Me!
K-9
Feline
Forms
Donations
The Plan
Contact
CommUnity
Event Calendar
I Want to Adopt
I Want to Foster
Surrender My Pet
Find a Foster for My Pet
I Want to Help!