Surrender Form

I, the undersigned owner/guardian, hereby voluntarily and permanently surrender the dog described in this agreement to the Mid-Michigan Pug Club and Rescue. By signing this document, I transfer all ownership rights, title, and interest in this animal to the Mid-Michigan Pug Club and Rescue. I understand that this surrender is permanent and irreversible, and I waive any future claim to ownership, possession, or control of the animal. I acknowledge that the Mid- Michigan Pug Club and Rescue may place the dog in a foster home, transfer the dog to another rescue, adopt the dog to a new owner, or make humane end-of-life decisions if deemed necessary.

Owner information is confidential and will not be released. Please fill out all information as completely and accurately as possible.

Last Name *
First Name: *
Phone Number *
Email Address *
Confirm email
Veterinarian Name/Office
Veterinarian Office Address
Name of pug *
Pug's birthdate or age *
Spayed/Neutered *	NoYes
Does the pug take any medication?
Does the pug have any medical/health concerns? *
Up to date on vaccines *	NoYes
Has the pug ever shown signs of aggression (growling, snapping, biting, etc) toward another dog? If yes, explain *
Has the pug ever shown signs of aggression (growling, snapping, biting, etc.) toward a person? If yes, explain. *
Is the pug housebroken? *	NoYes
Is the pug crate trained?	NoYes
is the pug leash trained?	NoYes
Is the pug good with other dogs? *	NoYes
Is the pug good with cats? *	NoYes
Is the pug good with kids? *	NoYes
Please tell us anything further we should know about the pug:
Veterinarian Phone Number
Signature * By signing my name below, I certify that this is my electronic signature and that it is the legal equivalent of my handwritten signature.	Clear