RELEASE FORM

I, ___________________________________________, being the owner of the following collie/sheltie (circle breed):

NAME:_______________________________________

AGE:_________________

SEX:_________________

Hereby relinquish all claims and ownership of said animal to the organization known as the Collie and Sheltie Rescue of SE VA and members thereof.  I cannot reclaim this dog once the dog is in possession of the Collie and Sheltie Rescue or members thereof.  I may, however, apply to the organization for adoption of the animal and understand that the final decision of return of the animal belongs exclusively to the members of the Collie and Sheltie Rescue.  I agree to give the Collie and Sheltie Rescue the dog’s AKC registration papers, if any, and all medical records available.  If the dog is not spayed/neutered, then I further agree to pay a $75.00 fee to help cover the cost of the procedure.  The Collie and Sheltie Rescue shall attempt to find the animal a suitable home, but neither the organization nor members thereof shall be held responsible for actions of the adoptive family and/or the dog.  The dog may be euthanized if deemed necessary.

I certify that this dog is not vicious and has never shown signs of aggressiveness towards human beings or animals, and I understand and agree to the above conditions.

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