Please complete and submit the form below. Every field with a red asterisk (*) must be completed in order for the form to be submitted. If required fields are skipped or not completed, the form will not submit.

I attest that I am the legal owner of this canine, and I hereby surrender him / her to the Stafford SPCA for placement in an appropriate home, to be determined in cooperation with Stafford SPCA staff and/or trained volunteers. I do this of my own free will. I further understand and agree that I am relinquishing all rights of ownership to this canine once it is placed in a new home, as determined by the Stafford SPCA. I also understand that, upon relinquishment, I may place no demands upon the either the adopter, nor the Stafford SPCA to maintain contact with this canine, or request information about the new owner(s). All information I have included in this form is truthful and accurate. I understand that the Stafford SPCA is not taking physical possession of this canine, and makes no guarantee to place this canine, in a specified time limit, or ever. I understand that the Stafford SPCA has the right to, and will list this canine on the SPCA’s reasonably available online and print media (ie: PetFinder.com, Website, Emails & Newsletters, Facebook & other social media) to effectively aid in the placement of him/her. By signing below I agree to the conditions above and agree to pay a $49.00 placement/listing fee, payable to: Stafford SPCA, 140 Andrew Chapel Rd., Stafford, VA 22554. The $49 listing fee is non-refundable, regardless of the eventual outcome of adoption efforts, and is earned and due at time of signature below. I further understand and agree that there will be a separate adoption fee (minimum of $99) assessed to the adopting party as part of the SPCA listing and placement efforts.