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Shelter/ACO Release Contract - SA

Chesapeake Bay Retriever Relief & Rescue, Inc.

Shelter/ACO Release Form and Policy Statement

As a representative of the , for the following Chesapeake Bay Retriever, I, the undersigned, understand that I completely relinquish ownership and ALL RIGHTS to this Chesapeake Bay Retriever when I surrender him/her to Chesapeake Bay Retriever Relief & Rescue, Inc. on April 18, 2024.

Dog’s Name:
Color:
Age:
Sex: Sex MaleFemale

Neutered: Neutered YesNoUnknown

Identifying marks/tattoos/microchip:

I understand that it is the goal of CBRR&R to attempt to give each appropriate Chesapeake Bay Retriever every possible chance for a loving new home. However, any Chesapeake Bay Retriever who is found to be suffering from an incurable disease that may compromise the quality of the dog's life, or who demonstrates biting, snapping, or aggression towards people, or who exhibits severe and unreasonable aggression toward other dogs, or severe behavior problems which render him not adoptable, will be euthanized. Euthanasia is a humane method of putting a creature to death by a painless injection of sodium pentobarbital. This is a last course of action, however. I/we warrant and represent that the dog has never bitten or menaced any individual. To the best of my/our knowledge and belief, the dog has never exhibited a propensity for aggressive behavior or biting. I also warrant and represent that the dog has no unexplained injuries or bite marks. I understand that the CBRR&R and any subsequent potential Adopters of the dog will be relying on the representations contained herein, in order to make decisions regarding the placement and adoption of the dog.
I have read and understand the policies stated above and I hereby release all ownership of this Chesapeake Bay Retriever, known as , and assign ownership to CBRR&R.

Name:
(Please print name of person relinquishing dog to CBRR&R)

Shelter/ACO Address:
Telephone:

Name of CBR Representative:
(Please print name of CBRR&R representative)

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

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May 23, 2019 11:59 am EDT

Shelter/ACO Release Contract - SA Uploaded by CBR Admin - [email protected] IP 100.34.134.51

June 5, 2019 4:24 pm EDT

eSig Group - [email protected] added by CBR Admin - [email protected] as a CC'd Recipient Ip: 174.201.12.40

July 8, 2019 8:56 am EDT

eSig Group - [email protected] added by CBR Admin - [email protected] as a CC'd Recipient Ip: 108.52.8.3

September 3, 2019 10:18 am EDT

eSig Group - [email protected] added by CBR Admin - [email protected] as a CC'd Recipient Ip: 100.34.134.51