Surrender a Dog

Name *

First and Last Name

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

###

####

Home Phone *

(###)

###

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Approximate Weight *

15 lbs or less

16-30 lbs

31-45 lbs

46-60 lbs

Over 61+ lbs

Socialization *

Sweet and social

A little shy but warms up

Very shy

Definitely abused

Fear biter

Reactive

Do you agree to us contacting your vet? *

Yes, I agree

No, I do not agree

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in Tails of the North Inc. (TOTN) seeking damages for the unexpected costs transpired from the untruthful answers. I certify that the above information is correct, and I understand that the information will be verified. I understand that by submitting this form electronically, I agree to release and covenant to hold harmless TOTN and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the surrendered dog. I agree to have TOTN call my references and conduct a home visit inspection to be able to approve my surrender application. By clicking the submit button, I agree to signing a legally binding surrender agreement superseding this agreement with TOTN, prior to the transfer of the surrender dog from me to TOTN. This is in addition to the Terms and Conditions of this application form. This is a legally binding surrender contract. TOTN 55 Jarvis Street PO Box 55 Fort Erie, ON L2A 5M6 tailsofthenorth@hotmail.com *

Yes, I agree

No, I do not agree