Rescue Transfer Form

Transfer From Organization:

Authorizing Contact:

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Name:

Age/Date of Birth:

Breed

Gender

Spayed/Neutered or Intact?

Mircochipped?

If the dog is microchipped, please provide microchip number:

Dog's Weight:

In pounds, please! don't make us do math. :) If known, just let us know.

Color/Markings:

Any Medical Concerns:

Medications:

Include dosage & schedule

Vaccinations Up-to-date

Behavior Concerns or Notes:

Has the dog ever growled, lunged or snapped, to your knowledge?

Has the dog ever bitten anyone, to your knowledge?

Please upload veterinary records

The undersigned, as an authorized representative of the releasing organization, confirms that the information provided above is accurate to the best of their knowledge and that the organization is transferring full ownership of the listed animal(s) to Evergreen Pug Rescue, with no ownership rights retained.

Ownership will transfer to Evergreen Pug Rescue once the animal(s) are received by Evergreen Pug Rescue or its designated transporter, or if Evergreen Pug Rescue begins covering veterinary care needed for transport—whichever occurs first.

The releasing organization authorizes Evergreen Pug Rescue to request, share, and transfer all medical records, and to update or register any microchip associated with the animal(s) without requiring additional approval.

Evergreen Pug Rescue will provide care, veterinary support, and placement for the animal(s) in accordance with its rescue policies.

Signature

Date

Rescue Transfer Form

Dog Details

Health & Behavior

Documents

Transfer of Ownership & Authorization