Animal Relinquishment Application
This is an application to relinquish your pet to Sadie's Safe House Chihuahua Rescue. If you're applying to relinquish more than one pet, please complete a separate application for each animal. Completion of this application does not guarantee acceptance into our program. Incomplete applications will automatically be rejected. Please note that a surrender fee of up to $150 may be required if your animal is not spayed/neutered or up-to-date on vaccines (with the exception of animals originally adopted from Sadie's Safe House).
What is the name of the pet you are applying to relinquish to our program? *
Your answer
Did you adopt this pet from Sadie's Safe House Chihuahua Rescue? *
Did you adopt this pet from another rescue organization? *
If you DID adopt this pet from another rescue organization and have a mandatory return clause in your contract, have you contacted said rescue and received permission to surrender your pet to another rescue? *
Surrendering Owner Information
Name (First & Last): *
Your answer
Address (Must include house number, street name, city, state, zip code and apartment or unit number if applicable): *
Your answer
Phone Number: *
Your answer
Email Address: *
Your answer
Pet Information
Gender: *
Breed: *
Color/s: *
Your answer
Does this animal have a recorded bite history? *
Is this animal crate trained? *
Is this animal vocal (Barking, yowling, whining, etc.)? *
Is this animal potty trained? *
Is this animal a digger (under fences, carpets, barriers, etc.)? *
Is this animal a jumper (Fences, adults, children, gates, etc.)? *
Is this animal obedience trained? *
Does this animal get along with cats? *
Does this animal get along with dogs? *
Does this animal like to chew? *
Does this animal travel well in a vehicle? *
Does this animal get along with children of all ages? *
Does this animal get along with all men? *
Does this animal get along with all women? *
Has this animal ever attacked another animal? *
Has this animal ever attacked a person? *
Is this animal up-to-date on core vaccines (DA2PP or DHPP for dogs and FVRCP for cats)? *
Does this animal have a current Rabies vaccine (Certificate proof will be required)? *
Please provide the contact information for the last Veterinarian that this pet was seen by. Include the Doctor's Name, Clinic Name, Clinic Address and Clinic Phone Number. *
Your answer
Is there anything else you think we should know about this pet or anything you'd like to elaborate on?
Your answer
Agreement
By submitting this form, I certify that I am the legal owner of the animal named in this application and the animal is free and clear of all other interests. I understand that if my pet is accepted into the Sadie's Safe House Chihuahua Rescue program, I am voluntarily giving up ownership of this pet to said rescue. If my pet is chosen, the following terms will apply: I understand that this agreement is final and even if the health of this pet improves, I will not have this pet returned to me. I may be asked to provide a surrender fee of up to $150 for relinquishing my pet and I understand that this is non-refundable. With this agreement, I understand that any medical services and their fees that are involved from this point forward are NOT my financial responsibility. Also, if the rescue decides to euthanize this animal, I understand that I will not be contacted. I certify that this dog is not possessed of any dangerous or vicious propensities unless stated above, and that I have not willfully concealed information about the dog that might indicate such propensities. If veterinarian information is provided, I authorize the release of all information and records pertaining to the above animal. I hereby forever release, discharge and agree to hold harmless and indemnify Sadie’s Safe House Chihuahua Rescue, its board of directors, its members, officers, and agents from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of the above named animal.
By providing my electronic signature below, I certify that I have read, understand and agree to the above statements. *
Your answer
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