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Release of Ownership Agreement

After completion and submission of this agreement, you should receive a copy via e-mail shortly. Please be sure to enter a valid e-mail address before submitting the agreement.

 

PART I

Instructions: Part I of this Release of Ownership Agreement (this "Agreement") is designed to provide Col. Potter Cairn Rescue Network with adequate information on the Cairn Terrier or Cairn Terrier mix (now referred to as the "Cairn") that you are releasing to Cairn Rescue. 

General Information



Please supply us with any prior known history of this Cairn if you have not had the dog since it was a young dog:

Spell Check





If purchased from a breeder or adopted through a rescue organization, please provide the following information: 

Spell Check

Breeder Information 

If you obtained this Cairn from a breeder, please answer the following questions:



 

 

 



Identification






If the Cairn is tattooed, please provide the following information, and have any documents available: 


If the Cairn is microchipped, please provide the following information, and have any documents available: 


Spell Check

Diet and Treats  

Please list in detail the brand and type of food you feed (both dry and moist). Include the measured amount fed, feeding time(s), and any special instructions for preparation (such as, mixed with broth or water): 

Spell Check

If yes, for what reason? 

Spell Check

If yes, please list these: 

Spell Check

List any treats or special snacks by brand, type and frequency: 

Spell Check

Medical and Health

The information you provide in this section will be used by Cairn Rescue to (i) determine the feasibility of placing the Cairn in an adoptive home and (ii) make an informed decision with respect to the allocation of rescue resources then available.

Your submission of this Agreement (i) authorizes Cairn Rescue to contact the veterinarian listed below and obtain copies of any and all veterinary records for the Cairn if Rescue considers it necessary or advisable, and (ii) irrevocably authorizes the veterinarian listed below to provide such records to Cairn Rescue and candidly discuss the health of the Cairn with Cairn Rescue.

Veterinarian Information 

Inoculations and Annual Health Care  

Please provide the following inoculation information: 






If yes, please provide the following: 



If yes, please provide the following:

Spay/Neuter  


In the event of a female Cairn, do you have any documentation to prove that she was spayed; such as a discounted rabies certificate? 


If your Cairn has not been spayed/neutered and is less than 9 years old, would you be willing to have spay/neuter done prior to surrender or financially aid Rescue in having this done? 


Teeth

If the Cairn's teeth are in need of cleaning, would you be willing to have the teeth cleaned prior to surrender or financially aid Rescue in having this done? 


Eyes


If yes, please provide details: 

Spell Check

Has the Cairn ever suffered any serious diseases including, without limitation:
Diabetes, Cushings or Addison's disease, thyroid, epilepsy or seizures, hip dysplasia, skin allergies, incontinence, luxating patellas, heart or breathing difficulties, liver, bladder or digestive problems?


If yes, please provide details: 

Spell Check

If yes, please provide details: 

Spell Check

Temperament/Training  















If yes, please provide details: 

Spell Check

Please list at least three favorable characteristics a new owner may want to know about the Cairn: 

Spell Check

Please list any NEGATIVE characteristics a new owner needs to know about the Cairn: 

Spell Check

What are three traits you would change about the Cairn if you could? 

Spell Check

If yes, please provide details: 

Spell Check

Please tell us about special toys, games, ways they enjoy being petted, belly or ear rubs, brushing or grooming preferences: 

Spell Check

Please explain in detail why you are giving the Cairn up for possible adoption:

Spell Check

If yes, please provide the Name & Phone Number of the trainer:  

Personal Information

Driver's Licence#
(ID required upon surrender)

To help us in our efforts to rehabilitate and rehome Cairn terriers, would you be willing to make a taxdeductible donation to our organization if we take your Cairn into our program? 


PART II


Terms of Release and Surrender

This is a legally binding document for the irrevocable surrender of your Cairn to Cairn Rescue. Please read it carefully and completely before signing it. Take as much time as you need to fully consider this important decision. If you have any questions, please contact us.

Your signature will be required prior to surrendering your Cairn. You must also provide proof of being of legal age in your state to sign contracts. Photographic identification with your current address will be required prior to surrender. ol. Potter Cairn Rescue Network Release of Ownership Agreement Page 7 of 7 For good and valuable consideration, the receipt and sufficiency of which I hereby confirm and acknowledge, I, being over the age of 18 years and of sound mind, hereby irrevocably and unconditionally surrender to Cairn Rescue for placement and adoption, the Cairn described in Part I of this Agreement.

I understand that by executing this document, I am giving up forever all right, title and interest to such Cairn, and that all future decisions regarding the placement of this animal will be made solely by Cairn Rescue. I also understand that if this Cairn is later found to have such an unpredictable temperament as to be unsuitable for any placement, or if the Cairn's quality of life is substantially impaired, in the opinion of a competent veterinarian, by a chronic, irreversible and/or painful condition, Cairn Rescue may consider euthanasia as a final alternative to adoptive placement.

I represent and warrant that the information provided on Parts I and II of this Agreement is the truth to the best of my knowledge and belief and agree (jointly and severally if this Agreement is executed by more than one owner) to hold Cairn Rescue, its officers, directors, representatives and volunteers, and any other group or organization that may place this Cairn in reliance on the information provided in this Agreement, harmless from any loss or injury resulting from any false information or misrepresentations that I may have submitted or made in this Agreement.

I further represent and warrant to Cairn Rescue, its officers, directors, representatives, and volunteers, that I (and if applicable, any other signatories to this Agreement) (i) am/are the sole owner(s) of this Cairn (ii) have full power and authority to surrender this animal for adoption (iii) am/are the only person(s) listed as the registered owner(s) of this animal with the AKC (if said Cairn is registered).

If the Cairn is AKC registered and I have indicated in Part I that I am able to provide AKC Registration Papers for the Cairn to Cairn Rescue, I agree to deliver to Cairn Rescue a properly signed transfer of such AK registration papers, omitting the name of the transferee, and hereby designate and authorize Cairn Rescue as my agent and attorney]

Please make sure the application is complete before pressing the "Submit" button below. Incomplete applications may be rejected or delayed.