Individual Surrender Form

Individual Surrender Form

Fields marked with an * are required

Owner Information

Bulldog Information

Current Veterinarian Information

Other Information

Please contact your vet and request they send your dog’s medical records to [email protected]
A $50.00 donation is required for the surrender of any pet.

Surrender Request Agreement

By entering my full legal name and clicking the submit button, I certify that I am the legal owner of this dog, and I attest and warrant that I have been truthful and answered all of the above questions to the best of my knowledge.

I also request and authorize the veterinarian listed above to release all medical information for my pet to Indiana Bulldog Rescue.  I release the veterinarian and staff from any legal responsibility or liability for the release of information to the extent indicated as authorized herein. This authorization expires 90 days from the date of signature. I understand I may revoke this authorization, but the revocation may not be applied retroactively once the information specified herein has been released.