I represent and warrant that I am the lawful owner of the Animal(s) I am wanting to relinquish. I have full power and authority to surrender these Animal(s) to MDF. No other person has any legal or equitable ownership interest in the Animal(s).
All fields must be filled out.
I understand that by filling out this surrender form does not guarantee The Moon Dog Farm will take my Animal(s). I understand MDF might be unable to take my pet at the time of this inquiry.
I will disclose to MDF all material information regarding the medical and behavioral history of the animal. I willfully surrender all medical records and information pertaining to the Animal(s). MDF has my permission to contact my veterinarian for any necessary information pertaining to the Animal(s) and I hereby consent to the release of any and all medical information by the medical provider.
I acknowledge that I am releasing the Animal(s) completely and voluntarily and that no representations, considerations or promises of any kind have been made to me by MDF or any of its representatives.
I understand by releasing the Animal(s) to MDF, I relinquish all ownership or other interest in the Animal(s). I will not seek further information about the Animal(s). I will not press MDF for details. My contact with the Animal(s) terminates at the time of surrender. MDF is under no obligation whatsoever to follow up with information.
I hereby release and forever discharge MDF from any and all rights, claims, obligations, liabilities and causes of action whatsoever arising out of or relating to the ownership. Possession or disposition of the Animal(s), and I agree to indemnify and hold harmless MDF from and against any and all such rights, claims, obligations, liabilities and causes of action which may be asserted by third parties.
I certify that this pet has been in my custody and under my supervision and that, to the best of my knowledge, has not bitten any person or animal or has not been exposed to rabies within the past 10 days.
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Please send donations to:
The Moon Dog Farm
PO Box 1552
Sauk Village IL 60411
The Moon Dog Farm is a 501c3 non-for-profit organization in South West Suburbs of Chicago, IL.