Relinquishment Agreement
Email address
Date
MM
/
DD
/
YYYY
Owner's Name
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Phone Number:
Your answer
Cell Phone Number
Your answer
Pugs Name:
Your answer
Male/Female
Age:
Your answer
Spayed/Neutered
Rabies Tag No:
Your answer
Shots:
Last Visit to the Veterinarian?
MM
/
DD
/
YYYY
What was this visit for?
Your answer
Microchip?
Microchip Company and ID Number:
Your answer
How did you acquire this pug?
Your answer
How long have you owned this pug?
Your answer
Has this Pug had previous homes/How Many?
Your answer
Reason for Surrendering. (Please be totally honest, there is nothing that will disqualify your pug from coming into the rescue)
Your answer
Does this pug get along with dogs, cats, children, babies, toddlers, other household pets?
Your answer
Have they ever snapped at or bitten anyone and what were the circumstances involved?
Your answer
Is there anything your pug does NOT like?
Your answer
What is your pugs temperament/personality?
Your answer
Is this pug crate trained?
Is this pug house trained
Where is this pug used to being kept (indoors, outdoors, crate, etc.)
Your answer
Is this animal used to being kept on/in (Please check all that apply)
Required
What type of food have they been eating, how much and how often?
Your answer
What type of training, commands or tricks do they know?
Your answer
What are their favorite toys?
Your answer
Where are they used to sleeping?
Your answer
Current Veterinarian's Name, address and phone number?
Your answer
Are you including a copy of their medical records?
What name are the medical records under?
Your answer
Please detail any previous medical issues. (Remember to please be thorough and honest. Again there is nothing that will disqualify them from being accepted into rescue)
Your answer
It is expressly understood by the parties to this Agreement that Relinquisher is the owner of said pug or has permission directly from the owner of said pug to voluntarily release the above name pug dog to the Group free and clear of any claim of ownership, and guarantees that no claim of ownership will ever be made against said dog.
Relinquisher represent and warrants that he/she is the sole owner of this dog and/or has the full complete legal right to relinquish said dog to the Group
Relinquisher provides information regarding the temperament, behavior characteristics and any medical problems and treatments of the dog being released on the above sections of this form which shall be made part of this agreement and states that they are true and correct to the best of their knowledge.
Relinquisher further warrants that this dog has never bitten anyone unless disclosed above.
The Group agrees to hold Relinquisher harmless for any action of the dog after it is released to the Group unless there is an undisclosed history of aggressive episodes.
In the case of the above, the Relinquisher shall be solely and completely responsible for the actions of the dog prior to the date set forth in paragraph one above.
This agreement shall be governed by the laws of the State of Idaho and effective the date previously assigned above on this form.
Your answer
Relinquisher's Signature
Your answer
Printed Name
Your answer
Pug Pals Inc., P O Box 191175, Boise, ID 83719
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms