Save a Dog Relinquishment Information Form

Save A Dog Relinquishment information form

Your Name:______

Organization Name:______

Address: ______

Phone: ______

Dog’s Name:

Breed:

Sex:

Age:

Coloring:

Spayed/Neutered?Have Certificate?

Feeding Schedule:

BRAND of Food:

Known Allergies or medical conditions (please describe):

Why are you giving the dog up?

Can the dog stay with you while we find it a new home? If not, what is your deadline for relinquishing?

Name/Phone of Previous Vet:

Is this dog currently on any medications? If yes, please list with dosages.

Vaccinations (Please FAX your dog’s medical and vaccination history to us at 877-349-9254):

Date of Last Distemper:

Date of Last Rabies:

Have Certificate/Tag?

Date Of Last Bordetella:

Date of Last Heartworm Test:

Results:

Is this dog currently on HW preventative?

Brand:Last Date Given:

Is this dog currently on Flea/Tick preventative?

Brand:Last Date Given:
Is this dog paper trained/crate trained/other. Has dog ever been in a crate at all? (please describe):

Does this dog have any obedience training / know any commands (please describe).

Where did you get the dog?

Is this dog good with other dogs?

Is this dog good with cats?

Is this dog good with children?

Is this dog overweight? ______If so, why?______

Does this dog have any temperament issues that we should be aware of?

Has the dog ever bitten anyone? What were the circumstances?

Does this dog Jump Fences? Dig Under Fences? Trained on invisible Fence? Please explain.

Is there anything else that we should know?

Are you willing to make a donation to HELP US WITH EXPENSES? We require a minimum $150 donation if your dog is up to date on vaccines and neutered.

______

(I / we) fully understand that by executing this document and delivering the above-described dog to Save A Dog, Inc. that (I / we) hereby relinquish any and all legal, and equitable rights of ownership of the above-described dog.

(I / we) represent that (I / we) are the lawful owner(s) of, and have good title to and the right and power to gift, sell, assign, transfer, convey and deliver said dog; and that said dog is free and clear from claims of ownership or other encumbrances of any kind or nature whatsoever by any other person or entity.

(I / we) understand that Save A Dog will act in the best interest of said animal in its care and placement. By assuming ownership, Save A Dog reserves all rights in regards to making all decisions in regards to the dog’s care, placement and medical treatment.

(I / we) understand that Save A Dog has the right to return dog to owner if said dog shows aggression in the foster home.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ______, 20___.

Signature:

Printed Name:

SIGNED, AND DELIVERED IN THE PRESENCE OF:

Save A Dog, Inc.
P.O. Box 1108
Framingham, MA01701
vmail: 508-877-1407 fax: 877-349-9254