Pound PuppyZ
Owner surrender Form
I am hereby relinquishing all rights of ownership to my dog by surrendering it to to the Pound PuppyZ Rescue. In signing this form, I am stating that I am the rightful and sole owner to the dog listed below. By signing this form and having received endorsement by an official Pound PuppyZ representative, I acknowledge that I have surrendered all rights of ownership for said animal.
Signature: *
Your answer
Date: *
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I hereby attest to my knowledge, this dog has shown no signs of aggression to humans or other animals nor has bitten a person at any time. (initial)
Your answer
I hereby attest to the best of my knowledge, this dog has no known illnesses or life threatening diseases. (initial)
Your answer
Name: *
Your answer
Address: *
Your answer
Phone: *
Your answer
Email: *
Your answer
Dogs Name: *
Your answer
Dogs age and birth date (Approximate):
Your answer
Dogs Breed:
Your answer
Veterinarian Name and Number:
Your answer
Reason for surrender: *
Your answer
Please fill out the following information below to help us understand the dogs' current needs as well as helping us to ensure the dog is placed in a suitable home.
Good with other dogs? *
Good with cats? *
Good with children? *
Leash trained?
Potty trained?
Crate trained?
Rides in car?
Able to swim?
Please list any likes/ dislikes and additional comments:
Your answer
Medical:
Spay/ Neutered?
microchipped?
Current on vaccines?
Date of last vaccines:
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List vaccines given:
Your answer
Please list any current or past medications:
Your answer
Has the dog ever had any reactions to medications or food? Please list any known allergies:
Your answer
Brand of dog food and feeding schedule:
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I certify all information is correct and accurate to the best of my knowledge: (sign and date)
Your answer
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