MIDLAND GOLDEN RETRIEVER CLUB

President:      Mr K A W Young
     Vice-President:   Mr G White

Chairman: Miss P Gowland                                                                                                        Rescue Co­ordinator: Vice­Chairman:  Mr J Truman                                                                                                     Mrs I. Pinfield

Hon Treasurer:                                                                                                                                            Hon Secretary: Mrs B. Liggins                                                                                                                               Miss L Layland
62 Brackenwood Drive                                                                                                          112 Top Street
Widnes                                                                                                                                       Appleby Magna
Cheshire                                                                                                                                    Swadlincote
W8 8GE                                                                                                                                      DE12 7AH           

AGREEMENT TO TRANSFER OWNERSHIP OF RETRIEVER DOG(S) AND/OR BITCH(S) INTO M.G.R.C. RESCUE
I/We, the undersigned, confirm that I/we are the legal owners of the Dog(s) referred to hereafter and  I/we hereby give my/our golden retriever dog(s) and/or bitch(s) named  	

          Microchip No:                                                                  Neutered/Entire

into  the ownership of Midland Golden Retriever Club, unconditionally, and  of  my/our own volition, to  find a home  for the said Dog(s).  I/We have approached Midland Golden Retriever Club and I/we
renounce all claim to the aforementioned Dog(s) now and in the future.

SIGNATURE 1:

DATE:  	

SIGNATURE 2:

DATE:  	

NAME(S):                                                                                                                                            (Full Name)

ADDRESS                         	

             (Post Code)  	

Home  tel number:                                                                    Mobile:   	

Email address:

AUTHORISED BY AGENT
OF THE CLUB (Signature)           	

DATE:  	

                                                Mrs. I. Pinfield   Rescue Co­ordinator
Leigh Lodge, Cladswell Lane, Cookhill, Alcester, Warwickshire ‐ B49 5JT      
Tel: 01527 892578   Mob: 07968 245087
Email: tilldawngoldens@btopenworld.com