DATE:______ BREED:___________ SEX: M/F ALTERED: Y/N AKC#________ COLOR:________ DOG'S REG. NAME:______________________ CALL NAME:_______________________ AGE:______ OWNER'S NAME:________________________________________ PHONE:_______________________ OWNERS ADDRESS:____________________________________________________________ ___________________________________________________________________________ HOUSETRAINED: Y/N CRATE TRAINED: Y/N LEASHTRAINED: Y/N BARKER: Y/N DIGS: Y/N DOG AGGRESSIVE: Y/N JUMPS FENCE: Y/N OBEDIENCE TRAINED: Y/N SHOT RECORD:_______________________________________________________________ WORMED:____________________________________________________________________ TYPE OF DOG FOOD:_____________________ FEEDING PERDAY: AM___ PM___ BOTH___ BREEDER:___________________________ VETERINARIAN:_________________________ DOG DOES... Sleeps in house__ Sleep on bed or furniture__ does tricks________________ Gets along with cats__ Gets along with other animals______________________ Chews________ Ride well in car_________ Behavior with children___________ HAS YOUR DOG EVER ATTACKED ANOTHER ANIMAL: Y/N ATTEMPTED TO BITE: Y/N HAS YOUR DOG EVER BITTEN A PERSON: Y/N ATTEMPTED TO BITE: Y/N ___________________________________________________________________________It is understood that Rescue does not buy or pay for dogs. This is a service to help place (your breed) in new homes when their present owners can no longer keep them. This service is free, however a donation to help pay for expenses is appreciated.
Please read, sign and date the following:
I,___________________________ ,hereby make available for adoption, the Fox Terrier, named_________________________, to (the name of your rescue) RESCUE. I certify that I am the owner of this dog, free and lear of all other interests. I certify that this dog is not possessed of any dangerous or icious propensities, and that I have not willfully concealed information about the dog that might indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify the (name of your rescue) 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 dog.
OWNER'S NAME:______________________________________________ DATE:__________I also agree my name and phone number may be released to the new owner of this dog. And that the new owner may contact me if he wishes, to gain any further information on this dog.
SIGNED BY OWNER:___________________________________________ DATE:__________Back