Stray/Owned Puppy Relinquishment Form - Colorado Animal Rescue

My Information

Name:*

First Last

Date:*

Physical Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mailing Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Cell Phone Number:*

Alternate Phone Number:

E-mail:

Animal Information

Stray/s or Owned? (please select one)*

In what town did you find the puppy/s?*

Address or detailed description of location:*

What is the time period you have had the puppy/s?*

How long? (Number)*

Name of puppy/s:*

Breed or Mix:*

Age or Birth Date of puppy or litter? (please write "unknown" if not known)*

Single Puppy or Litter?*

Single

Litter

Have any in the litter died?*

Yes

Unknown

Please describe circumstances.*

Why are you surrendering your puppy/litter?*

How many in the litter?*

Did you bring them all in?*

Yes

Where are the others?*

Do you know what happened to the mother?*

Normal urination and defecation?*

Yes

Unsure

Please explain abnormalities.*

Have you fed the puppy/s while in your care?*

Yes

What brand of food have you been feeding the puppy/s?*

What form of food is preferred by the puppy/s? (select all that apply)*

How often has food been provided?*

How much food has been provided?*

What times have you been feeding the puppy/s?*

Do you own the mother of the litter?*

What is her breed or mix?*

What is her age?*

Is this her first litter?*

Yes

How many litters has she had?*

What happened with the puppies from the previous litter?*

Do you plan on getting her spayed?*

Yes

Do you need spay information or assistance?*

Yes

Is she current on vaccinations?*

Yes

Where and when did mom get her vaccinations?*

Does she have any medical problems?*

Yes

Please explain medical problems:*

Do you own the father of the litter?*

What is his breed or mix?*

What is his age?*

Do you plan on getting him neutered?*

Yes

Do you need neuter information or assistance?*

Yes

Is he current on vaccinations?*

Yes

Where and when did dad get his vaccinations?*

Does he have any medical problems?*

Yes

Please explain medical problems:*

Do you have a veterinarian?*

Clinic Name:*

Additional Comments:

E-Signature

Statement of surrender: By signing below I certify that I own the animal being relinquished, or am acting as the owner due to the owner being incapacitated or having abandoned the animal. I certify that the said animal/s have not bitten anyone in the last 10 days unless otherwise noted above. I hereby relinquish all rights of ownership to this animal/these animals to Colorado Animal Rescue, and agree that the disposition of this animal/these animals be at the discretion of the animal shelter. I understand that the animal shelter has the right to not disclose further information regarding the disposition and status of the animal/s.

Owner's Signature*

By typing your name in the box above, you attest that you have read and fully understand this form and certify that all information is true to the best of your knowledge.

This field is for validation purposes and should be left unchanged.