TERMS OF RELEASE AND SURRENDER FOR ADOPTION:

1. I, the undersigned, hereby IRREVOCABLY surrender to the All Breed Rescue Alliance of South Central Indiana for placement and adoption, a

Breed: _________________________________________________ described as follows:

Call Name: _________________ Registered Name: ______________________________

Sex: ____ Altered: ________________ Color: ________________________ Age_______

2. REPRESENTATIONS AND WARRANTIES – I/we hereby represent and warrant to the All Breed Rescue Alliance of South Central Indiana, their agents, successors and assignees that the undersigned are the sole owner(s) of the above described dog; that I have full power and authority to surrender this animal for adoption; that I am the only person(s) who are listed as registered owner(s) of this animal with the AKC; that no other person or persons' signatures are required to effect a valid transfer of AKC registration papers on this animal, and that no other person or persons have any legal or equitable ownership interest in this animal.

3. PERTINENT INFORMATION – I agree to provide the All Breed Rescue Alliance of South Central Indiana with any documents and all other available information concerning this dog which might assist in matching this dog with the proper prospective adoptive home, including health and shot records, pedigree, name and address of breeder or other person from whom the dog was acquired, and information concerning this dog's history.

4. CONSENT FOR CONTACT – I understand that the All Breed Rescue Alliance of South Central Indiana may contact the breeder, previous owner or veterinarian of the dog to provide additional background information, or otherwise assist in locating a suitable adoptive home and hereby give our consent to these efforts.

5. SURRENDER OF RIGHTS - By executing this document, I understand that we are giving up forever all right, title and interest to the above-mentioned dog and we further understand that all future decisions regarding placement of this animal will be made solely by the All Breed Rescue Alliance of South Central Indiana. I also understand that if this dog is later found to have such an unpredictable temperament as to be unsuitable for any placement, or if the animals quality of life is substantially impaired, in the opinion of a competent veterinarian, by a chronic, irreversible, painful condition, euthanasia may be considered as a final alternative to adoptive placement.

6. I, the undersigned, hereby specifically and forever release, and hold the All Breed Rescue Alliance of South Central Indiana harmless, from any and all liability arising from the placement for adoption by the Alliance, of the above-mentioned dog, or for any other actions taken by the Alliance in accordance with, and reliance on, the representations we have made, and the authorization we have provided under the terms of this document. I agree to indemnify and hold harmless the Alliance for any damages suffered and expenses incurred (including legal fees) in defending any legal action, whether for bodily injuries or death, property damage, breach of contract, or otherwise, whether instituted by us or by any other person or persons including the adoptive owners, arising out of or in consequence of the placement of the dog, in reliance on the authorizations, representations and warranties we have made in this agreement.

7. I certify that this dog is not possessed of any dangerous or vicious propensities, and that I have not willfully concealed information about the dog that might indicate such propensities.

8. In recognition that the All Breed Rescue Alliance of South Central Indiana, an all volunteer, non-profit breed rescue group is accepting this dog into rescue, I am donating $ ____________ towards it’s care and feeding.

9. Known conditions at the time of surrender:

THIS IS A LEGALLY BINDING DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR DOG TO THE ALL BREED RESCUE ALLIANCE. PLEASE READ CAREFULLY AND COMPLETELY BEFORE SIGNING. TAKE AS MUCH TIME AS YOU NEED TO FULLY CONSIDER THIS IMPORTANT DECISION.

I have read the proceeding and agree to the conditions set forth on this ____day of _________, _____.

Witnessed: