OWNER'S RELEASE AGREEMENT

DATE:______ BREED:___________ SEX: _____ ALTERED: Y/N AKC#________ COLOR:________

DOG'S REG. NAME:______________________________________________________________________

CALL NAME:_____________________________________________ AGE:__________________________

OWNER'S NAME:________________________________________ PHONE:_________________________

OWNERS ADDRESS:_____________________________________________________________________

HOUSETRAINED: _______ CRATE TRAINED: _______ LEASHTRAINED: _______ BARKER:_______

DIGGER: _____ DOG AGGRESSIVE:____ ESCAPE ARTIST: _____ OBEDIENCE TRAINED: ________

VWD CHECKED: ___________ VETERINARIAN: ______________________________________________

SHOT RECORD:____________________________________________________________________________

WORMED:_____________ HEARTWORM PREVENTION:____________________________________

TYPE OF DOG FOOD:_____________________ FEEDING PERDAY: AM_____ PM______ BOTH___

BREEDER:______________________________________________________________________________

DOG DOES...

Sleep in house______ Sleep on bed or furniture_________ Does tricks________ Gets along with cats_____

Gets along with other animals _____________ Chews_______________ Ride well in car______________

Behavior with children____________________________________________________________________

HAS YOUR DOG EVER ATTACKED ANOTHER ANIMAL: ________ ATTEMPTED TO BITE: ________

HAS YOUR DOG EVER BITTEN A PERSON:_____________ ATTEMPTED TO BITE: ________________

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It is understood that Rescue does not buy or pay for dogs. This is a service to help place Scottish Terriers in new homes when their present owners can no longer keep them. This service is free, however a donation to help pay for expenses is appreciated.

Please read, sign and date the following:

I,___________________________________ ,hereby make available for adoption, the Scottish Terrier,

named _________________________, to ___________________________ an agent of SCOTTISH TERRIER RESCUE. I certify that I am the owner of this dog, free and clear of all other interests. I certify that this dog is not possessed of any dangerous or vicious propensities, and that I have not willfully concealed information about the dog that might indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify the Rescue entity, and agents from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of the above named dog.

OWNER'S NAME:______________________________________________ DATE:__________

SIGNATURE OF RESCUE AGENT: _______________________________ DATE: __________

I also agree my name and phone number may be released to the new owner of this dog. And that the new

owner may contact me if he wishes, to gain any further information on this dog.

SIGNED BY OWNER:___________________________________________ DATE:__________