Name
Approx Age / Date of Birth
Breed/Type
Microchip Number
Previous vet clinic name and contact details (if known)
Known medical conditions, medications, or pending vet visits
Behaviour notes (including any bite history, aggression, or incidents)
Full legal name
Address
Email
Phone Number
Government issued ID type and number
1. The Owner confirms they are the legal owner of the dog and have the full right to surrender the dog.
2. If there is any co-owner, partner, or other legal owner, all owners must sign this agreement.
3. The Owner confirms the dog is not stolen, not subject to dispute, and not part of any legal case.
4. The Owner authorises the Rescue to contact the previous vet(s) and request records relating to this dog.
1. Ownership transfers to Moon & Meadow Rescue at the time the dog is handed over to the Rescue (or to a person authorised by the Rescue).
2. From handover onwards, the Owner permanently waives all rights to reclaim the dog and agrees they are no longer entitled to decisions regarding the dog’s care, placement, or future.
1. The Owner agrees to provide honest and complete information about the dog’s history, including medical history, medications, behavioural concerns, and any known incidents.
2. The Owner confirms they have disclosed any bite history or aggression to people or animals to the best of their knowledge.
1. The Rescue will manage the dog’s care, rehabilitation, placement, and future adoption at its discretion, including receiving an adoption fee.
2. The Owner agrees not to attempt to locate, contact, or harass any future adopter and acknowledges that adopter details will not be shared.
1. Any outstanding veterinary bills, debts, or commitments incurred before surrender remain the Owner’s responsibility unless otherwise agreed in writing by the Rescue.
2. If the Owner has withheld or misrepresented relevant information (for example serious medical issues or bite history), the Owner agrees to reimburse the Rescue for reasonable costs directly resulting from the undisclosed information, where permitted by law.
1. The Owner understands surrender is final and agrees they have no future claim to the dog, no right to updates, and no right to determine the dog’s outcome.
2. The Owner agrees they will not make any financial claims against the Rescue now or in the future relating to the dog’s care, placement, adoption fee, or outcome, except where required by law.
1. The Owner releases Moon & Meadow Rescue from liability for decisions made after surrender regarding the dog’s care, treatment, placement, or outcome, except where required by law.
2. The Owner accepts responsibility for any consequences arising from false statements or withheld information in this agreement, and agrees to indemnify the Rescue for reasonable losses directly resulting from that misrepresentation, where permitted by law.
The Owner agrees to hand over all available items and documents, including: vaccination book, medical records, passport (if applicable), microchip documentation, and current medications.
Signatures
By signing, both parties agree to the terms above.
Owner Full Name
Date
Moon & Meadow Rescue Representative Name
Date
Attachments (if available): vaccination book, medical history documents, microchip documents, passport.
Submit