Surrender Application

Donation Offered
Amount for Surrender Fee is $250 to cover any medical costs that may be associated with the dog.

Agreement
I certify that the information provided on this form is true and accurate. I understand that by providing this information I am under no obligation to relinquish my pet and Marshall's Dog Rescue is under no obligation to accept my pet.
- Yes
- No
Please Explain
I understand and agree that should I surrender my pet to Marshall's Dog Rescue, this form acts as official authorization for my veterinary clinic to release any and all medical records to Marshall's Dog Rescue.
- Yes
- No
Please Explain
Once you have surrendered your pet to Marshall's Dog Rescue you will be unable to reclaim it.
Full Name*

By typing your full name above you are agreeing that you will be unable to reclaim your pet once surrendered to Marshall's Dog Rescue.