RELEASE AND SURRENDER FOR ADOPTION

TERMS OF RELEASE AND SURRENDER FOR ADOPTION:

1. I/we, the undersigned, hereby IRREVOCABLY surrender to the Scottish Terrier Rescue Agent for placement and adoption, a Scottish Terrier described as follows:

CALL NAME:_____________________________________ SEX:_______ COLOR:_______ AGE:_________

AKC REGISTERED NAME:__________________________________________ AKC #:_________________

2. REPRESENTATIONS & WARRANTIES - We hereby represent and warrant to Scottish Terrier Rescue, their agents, successors and assigns that the undersigned are the sole owner(s) of the above described Scottish Terrier. That I/we have full power and authority to surrender this animal for adoption, that I/we are the only person(s) who are listed as registered owner(s) of this animal with the AKC, the no other person or persons' signatures are required to effect a valid transfer of AKC registration papers on this animal, and that no other person or persons have any legal or equitable ownership interest in this animal .

3. DELIVERY OF REGISTRATION - I/we agree to (contemporaneously with the execution of this document within three days) deliver to the Scottish Terrier Rescue Agent a properly signed transfer of the AKC registration papers for the above described Scottish Terrier, omitting the name of the transferee. We hereby designate and authorize Scottish Terrier Rescue as our agent and attorney-in-fact for purposes of designating a transferee and inserting this name on the AKC registration transfer form.

4. OTHER PERTINENT INFORMATION - We also agree to provide Scottish Terrier Rescue with any documents and all other available information concerning this Scottish Terrier which might assist in matching this Scottish Terrier with the proper prospective adoptive home, including health and shot records, pedigree, name and address of breeder or other person from whom the dog was acquired, and information concerning this Scottish Terrier’s "dog history," such as important life events and individual personality quirks.

5. CONSENT FOR CONTACT - We understand that Scottish Terrier Rescue may contact the breeder or previous owner of the Scottish Terrier to provide additional background information, or otherwise assist in locating a suitable adoptive home and hereby give our consent to these efforts.

6. SURRENDER OF RIGHTS - By executing this document, we understand that we are giving up forever all right, title and interest to the above-mentioned Scottish Terrier and we further understand that all future decisions regarding the placement of this animal will be made solely by Scottish Terrier Rescue. We also understand that if this Scottish Terrier is later found to have such an unpredictable temperament as to be unsuitable for any placement, or if the animals quality of life is substantially impaired, in the opinion of a competent veterinarian, by a chronic, irreversible, painful condition, euthanasia may be considered as a final alternative to adoptive placement.

7. RELEASE AND INDEMNITY - I/we, the undersigned, hereby specifically and forever release, and hold Scottish Terrier Rescue harmless, from any and all liability arising from the placement for adoption by Scottish Terrier Rescue of the above-mentioned Scottish Terrier, or for any other actions taken by Scottish Terrier Rescue in accordance with, and in reliance on, the representations we have made, and the authorizations we have provided under the terms of this document. We agree to indemnify and hold harmless Scottish Terrier Rescue for any damages suffered and expenses incurred (including legal fees) in defending any legal action, whether for bodily injuries or death, property damage, breach of contract, or otherwise, whether instituted by us or by any other person or persons including the adoptive owners, arising out of or in consequence of the placement of the Scottish Terrier, in reliance on the authorizations, representations and warranties we have made in this agreement.

THIS IS A LEGALLY BINDING DOCUMENT FOR THE IRREVOCABLE SURRENDER OF YOUR SCOTTISH TERRIER FOR PLACEMENT TO AN ADOPTIVE HOME. PLEASE READ CAREFULLY AND COMPLETELY BEFORE SIGNING. TAKE AS MUCH TIME AS YOU NEED TO FULLY CONSIDER THIS IMPORTANT DECISION.

IF YOU HAVE ANY QUESTIONS, PLEASE CALL:

I have read the preceding and agree to the conditions set forth this__________ day of___________, 199____.

__________________________________________________

SIGNATURE OF OWNER

__________________________________________________

SIGNATURE OF CO-OWNER

ADDRESS: ____________________________________________________________________________

CITY, STATE, ZIP : ______________________________________________________________________

PHONE:__________________________________________________

Witnessed:

__________________________________________________

__________________________________________________

RESCUE MEMBER _________________________________