Dog Surrender Form

Name:*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Animals Name(s):*

Date:*

Date

Check the corresponding boxes to note as to whether or not the cat or dog has any behavioral concerns worth noting.

Is the cat or dog an escape artist?

YesNoUnknown

Does the cat or dog get anxious in the car/carsick?

YesNoUnknown

Is the cat or dog okay with children?

YesNoUnknown

Has the cat or dog ever injured a person?

Yes (explain)NoUnknown

Notes/Reason for Surrender*

Relinquishing Receipt for Animal Surrendered to The Hooff House Rescue and Sanctuary*

I hereby give The Hooff House permission to request all medical history and medical records from my Veterinarian for the pet I am relinquishing.I acknowledge that my signature on his receipt relinquishes all claims of ownership of the pet(s) described. I understand that unless otherwise approved by The Hooff House president this pet(s) will not be returned to me, once left in their or any of their foster's care. Neither my family, any representatives acting on my behalf, nor I may assert any claims, or otherwise against The Hooff House Rescue and Sanctuary with respect to this pet(s).I understand that if I find an adopter for the pet that I must notify The Hooff House Rescue and Sanctuary of this. The adopter must submit an application for approval and pay any applicable adoption fees within one week of notifying The Hooff House.I acknowledge that once the pet or pets are adopted out I will not get them back and there is no guarantee of updates.

Signature*