RELEASE FORM

As of this date, the undersigned Adoptive Owner is returning full and unconditional

ownership of the greyhound referenced below to:

Adoption Group:______________________________ City/State:____________

It is agreed that there are no claims regarding this greyhound against

Adoption Group:____________________________, any of it's agents or

representatives, or the previous registered owner of the dog.

The returning of this greyhound is done voluntarily and irrevocably.

Any vaccination records or other veterinary information concerning this dog should be given

to: Adoption Group:____________________________ City/State:____________

at the time the dog is returned.

Name of dog:______________________________________________

Ear tattoos: (right) ____________________ (left) __________________

Sex and color: ______________________________________________

Reason for return: ______________________________________________________

_____________________________________________________________________

____________________________________________ Date:_____________________

Adoptive Owner relinquishing ownership

_____________________________________________ Date: ____________________

Adoption group representative