Dog Relinquish Form – Hulls Haven Border Collie Rescue

Your Name *

Email Address *

Address *

Address

City

State/Province

Zip/Postal

Country

Home Phone *

Cell Phone

Dog's Name *

Breed *

Sex *

Male

Female

Age *

Spayed / Neutered? *

Yes

No

Do you have the Spay / Neuter Certificate?

Yes

No

Dog's Color *

Dog Food Brand *

Feeding Schedule *

Feed Amount *

Known allergies, medications, or medical conditions? *

Why are you giving the dog up? *

Are you able to foster your dog? *

Yes

No

What is your deadline for relinquishing your dog? *

Vaccinations *

Please provide us a copy of any receipts, certificates, tags you may have when relinquishing the dog.

Vet Name *

Vet Phone Number *

Last Vet Visit Date *

House broken? *

Yes

No

OtherOther

Crate trained? *

Yes

No

OtherOther

Used to being in a crate? *

Yes

No

OtherOther

Had obedience training? *

Yes

No

OtherOther

Know basic obedience commands? *

Yes

No

OtherOther

Good with other dogs? *

Yes

No

OtherOther

Good with cats? *

Yes

No

OtherOther

Good with children? *

Yes

No

OtherOther

Have any temperament issues? *

Yes

No

OtherOther

Overweight? *

Yes

No

OtherOther

Jump fences or dig under fences? *

Yes

No

OtherOther

Bitten anyone or attacked another dog? *

Yes

No

Please explain the bites that occurred and their severity *

How much exercise does your dog receive? *

What other organizations have you contacted regarding relinquishing your dog? *

Relinquishment Agreement *

(I / we) fully understand that by executing this document and delivering the above-described dog to Hull’s Haven Border Collie Rescue Inc. that (I / we) hereby relinquish any and all legal and equitable rights of ownership of the above-described dog. 

(I / we) represent that (I / we) are the lawful owner(s) of, and have good title to and the right and power to gift, sell, assign, transfer, convey and deliver said dog; and that said dog is free and clear from claims of ownership or other encumbrances of any kind or nature whatsoever by any other person or entity. 

(I / we) understand that Hull’s Haven Border Collie Rescue Inc will act in the best interest of said animal in its care and placement. By assuming ownership, Hull’s Haven Border Collie Rescue Inc reserves all rights in regards to making all decisions in regards to the dog’s care, placement and medical treatment. 

(I / we) understand that Hull’s Haven Border Collie Rescue Inc has the right to return dog to owner if said dog shows aggression in the foster home.

Checkboxes *

I agree to the terms and conditions in the relinquishment agreement.