OWNER TURN IN FORM

I, ________________________________________________________, an adult of legal age, do hereby voluntarily and irrevocably give, donate, surrender and release to Gulf Coast Cocker Spaniel Rescue, Inc. (hereinafter referred to as "GCCSR", the following animal(s), hereinafter referred to collectively as "Animal(s)".

Animal(s) Name(s):

Sex:

Age(s):

How long have you owned the dog?

Has the dog been on heartworm preventative?

If so, what brand?                   And on which date each month do you give the meds?

Are there any other medications the dog is currently taking?

I have disclosed to GCCSR all material information regarding the medical and behavioral history of the Animal(s).  I willfully surrender all medical records and information pertaining to the Animal(s).  GCCSR has my permission to contact my veterinarian for any necessary information pertaining to my Animal(s), and I hereby consent to the release of any and all medical information by any medical provider.

I further acknowledge that I am releasing the Animal(s) completely voluntarily and that no representations, considerations or promises of any kind have been made to me by GCCSR.

List any particular concerns or things that GCCSR should know about the Animal(s) - good and not so good.

I understand that by releasing the Animal(s) to GCCSR, I relinquish all ownership or other interest in the Animal(s). I will not seek further information about the Animal(s) and will not press GCCSR for details.  My contact with the Animal(s) terminates at the time of surrender.  GCCSR is under no obligation whatsoever to follow up with information about the Animal(s).

I hereby release and forever discharge GCCSR 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 GCCSR from and against any and all such rights, claims, obligations, liabilities, and causes of action which may be asserted by third parties.

Attorneys’ Fees and Costs.  If litigation is brought to construe, interpret or enforce this agreement or to recover damages for any breach of this agreement, the prevailing party shall be entitled to recover all reasonable attorneys’ fees, plus costs and expenses incurred, including the cost of any mediation.  Reasonable attorneys’ fees, court costs and expenses as used in this provision shall include, but is by no means limited to, actual litigation as well as reasonable pre-litigation activities, any alternative dispute resolution proceedings, as well as any and all appellate court proceedings.

Severability.  If any provision of this Agreement or any provision hereafter adopted shall for any reason be found to be inapplicable, invalid, illegal or unenforceable, such provision shall not affect the other provisions of this Agreement, but this Agreement shall be construed as if such provision had never been contained in the Agreement, or in the alternative, the provisions shall be modified to the extent of such inapplicability, invalidity, illegality or other unenforceability.

Applicable Law.  This Agreement is entered into in Harris County, Texas. Any disputes, controversies, or disagreements arising under this Agreement shall be settled by a court of competent jurisdiction located in Harris County, Texas.  This Agreement shall be governed by and construed and enforced in accordance with the laws of the State of Texas without regard to conflicts of law principles. 

Reliance.  Each party to this agreement expressly warrants and represents and does hereby state and represent that no promise or agreement which is not herein expressed has been made to such party in executing this Agreement and that no party is relying upon any statement or representation of any other party or any agent or attorney of any other party.

FINAL AGREEMENT.  THIS WRITTEN AGREEMENT REPRESENTS THE FINAL AGREEMENT BETWEEN THE PARTIES AND MAY NOT BE CONTRADICTED BY EVIDENCE OF PRIOR, CONTEMPORANEOUS, OR SUBSEQUENT ORAL AGREEMENTS OF THE PARTIES.  THERE ARE NO UNWRITTEN ORAL AGREEMENTS BETWEEN THE PARTIES AND EXCEPT AS EXPRESSLY SET FORTH IN THIS AGREEMENT, IT IS EXPRESSLY UNDERSTOOD AND AGREED THAT EACH OF THE PARTIES MAKE NO WARRANTIES, EXPRESS OR IMPLIED.  ANY MODIFICATION TO THIS AGREEMENT MUST BE MADE IN WRITING AND SIGNED BY EACH PARTY TO THIS AGREEMENT.

This is a legally binding document for the irrevocable surrender of your Animal(s) to Gulf Coast Cocker Spaniel Rescue.

I have fully read and understand this Surrender Agreement. I accept and agree to abide by its terms.

DATE:______________________

OWNER’S SIGNATURE: _____________________________________________________

OWNER’S NAME:          _____________________________________________________

OWNER’S ADDRESS:   _____________________________________________________

__________________________________________________________________________

OWNER’S PHONE NUMBERS:  (Home)__________________________(Work)________________________

                                                (Mobile) _________________________

OWNER’S E-MAIL:  _________________________________________

DONATION AMOUNT: ________________

Witness_________________________________

GULF COAST COCKER SPANIEL RESCUE INC.

Signature________________________________

Date ___________________________________