First & Last Name
Street Address City, State, Zip Code
Name of dog(s)
Breed of dog(s)
Age of dog(s)
I agree to the following:
By electronically signing below, I agree to surrender all ownership and rights of the above said animal to Francis Kennels. I also give permission for access by Francis Kennels to all medical records of this dog. I certify that all information on this form and all attachments are true. The undersigned hereby forever releases, discharges, covenants to hold harmless and indemnify for all costs Francis Kennels staff, volunteers or any official agents from any and all claims for damages, expenses, or actions arising out of any act or occurrence pursuant to this contract and/or conduct of said dog.
Please type your full name for an electronic signature.