First Name*

Last Name*

Email*

What is your Organization's name?*

What is your organization's address?*

What is the name of your Organization's Contact?*

What is the phone number for this contact?*

What is the email for this contact?*

What is the Animal's name?*

What is the animals microchip number?

What was the Date of Rescue?*

Where was the animal Rescued From?*

In the interest of saving animals, this shelter wishes to enter a Transfer Agreement with Ohio Fuzzy Pawz.  The above Shelter agrees with the following statements (Please select "I have read and acknowledge" from the dropdowns below).

Our Organization is a 501c(3) Authorized to house animals. *
Choose one: I have read and acknowledge the above statement.

We will provide proper care for all transferred animals including nutrition, containment, exercise, enrichment, socialization and medical treatment.*
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We agree transferred animals will not displace animals in our care and that transferred animals will not be euthanized for space nor used for breeding irg fighting purposes.*
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We will assume legal ownership of the animal and until legal adoption of the owner. *
Choose one: I have read and acknowledge the above statement.

We understand that most animals have unknown history and have been in a shelter environment, thus [transfer organization] is not able to insure the animals have not been exposed to pathogens, parasites, viruses, etc. We agree to defend, indemnify and hold harmless[transfer organization] and any of its Boards, Officers, Agents, Employees, Assigns, and Successors in Interest from and against all suits and causes of action, claims, losses, demands and expenses, including, but not limited to, attorney's fees and cost of litigation, damage or liability of any nurture whatsoever, for death or injury to any person, including our employees and agents, or damage or destruction of any property of either party hereto or of third parties, arising in any manner by reason of the negligent acts, errors, omissions or willful misconduct incident to the our performance under this Agreement. The provisions of this paragraph survive expiration or termination of this Agreement. *
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I have fully read and understand these conditions and agree to the conditions on behalf of the organization. The information contained in this application is true and correct. This mutual agreement can be terminated at any time, for any reason, by either party without notice. *
Choose one: I have read and acknowledge the above statement.