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ID# _______________________
Donation: __________________
RELEASE OF OWNERSHIP AGREEMENT
This form is designed to provide “HOME FOR DISPOSABLE PETS ” with adequate information on the dog you are relinquishing. It will be used to provide information to potential families considering this dog, to ensure that proper care of this dog is continued, and to protect both HfDP and the party relinquishing the dog.
GENERAL
Name of Dog: ___________________________________________________________
Breed:______________________________Sex:________________________________
Age (D.O.B.):________________________
Color:__________________________________________________________________
Does the dog have any scars or distinguishing marks? Yes No
If yes, please list : ______________________________________________________________________________
Is the dog spayed or neutered? Yes No
Do you have AKC registration papers on this dog? Yes No
Is the dog tattooed or micro-chipped? Yes No
If yes, Registry & Number:_________________________________________________Phone:__________________
FOOD
Type or brand of dog food given and feeding directions: ____________________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________
MEDICAL
Name of Veterinarian: ___________________________________________________
Address:______________________________________________________________
Phone:_______________________________________________________________
Is the dog current with the following vaccinations (attach copies of vet info if possible) ?
Rabies? Yes No Date last given?______________ DHLPP? Yes No Date last given?________________
Bordatella? Yes No Date last given?______________ Fecal? Yes No Date last done? _______________
HW Test? Yes No Date last done?______________ Is the dog on any heartworm preventative? Yes No
If so, brand and date last given? ____________________________________________________________________
Is the dog on flea and tick control? Yes No If so, brand and date last give ____________________________
Has the dog ever sustained major injuries? Yes No
If so, list: ______________________________________________________________________________________
______________________________________________________________________________________________
Has the dog ever suffered any serious diseases? Yes No
If yes, list: _____________________________________________________________________________________
______________________________________________________________________________________________
Does the dog currently have any condition that requires medical treatment or special care? Yes No
If yes, please describe: ________________________________________________________________________
Are you able to provide a complete medical record on this dog? Yes No
TEMPERAMENT / TRAINING:
Is the dog house trained? Yes No Don’t Know
Is the dog leash trained? Yes No Don’t Know
Is the dog crate trained? Yes No Don’t Know
Is the dog good with children? Yes No Don’t Know
Is the dog good with other dogs? Yes No Don’t Know
Is the dog good with cats? Yes No Don’t Know
If dog is NOT good with any other livestock or animal, please specify:
_____________________________________________________________________________________________
Has the dog ever bitten anyone? Yes No
Has the dog ever shown ANY signs of aggression (such as food, toy, gender, etc) ? Yes No If Yes, explain:
______________________________________________________________________________________________
Has the dog had basic obedience training? Yes No
Has the dog been known to dig? Yes No
Has the dog been known to climb? Yes No
Will you take the dog back if it does not work out in the foster home until an adoptive home can be found? Yes No
Please list any characteristics a new owner may want to know about the dog (Please elaborate as this is VERY HELPFUL): ______________________________________________________________________________________________
______________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Please explain why you are relinquishing the dog: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
RELEASE OF OWNERSHIP AGREEMENT
I agree and understand that I am giving up all rights of possession and ownership of the described dog and that I will not be able to redeem this dog at any time. I agree and understand that this dog is now the "sole property" of “HOME FOR DISPOSABLE PETS ”. I promise that the information I am giving is accurate, and that HfDP will not be held liable or chargeable for any false information or misrepresentations that I may have submitted on this form. I further agree and understand that HfDP will do whatever is necessary for the safety and well-being of this dog.
Previous Owner:
Printed Name: __________________________________________________________
Address:__________________________City________________State____Zip_______
Phone Number(s) :_______________________________________________________
E-mail Address: _________________________________________________________
Driver’s License Number:_____________________ Social Security #_______________
Signature: __________________________________________Date:_______________
Dog Received by:________________________________________________________
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