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Date:
Dog's (Registered) Name:
Call Name:
Sex
male
female
Spayed or Neutered?
No
Yes
Age
Weight
Birth Date:
Enter 01/01/1900 if unknown
Color:
general info owner
Owner's Name:
Home Phone:
Work Phone:
Email Address:
Owner's Street Address:
City:
State
AL
AR
FL
GA
KY
LA
MS
SC
NC
TN
Zip Code:
Dietary Information
Brand of Dog Food
Type (Kibble, Can, Other)
Feedings
Morning
Evening
Training
House trained ?
No
Yes
Crate trained ?
No
Yes
Leash Trained?
No
Yes
Obedience trained?
No
Yes
Behaviors and Characteristics
Barks
No
Yes
Digs
no
yes
Jumps fence
no
yes
Aggressive
no
yes
Rides well in vehical
No
Yes
Circles
No
Yes
Chews
No
Yes
Sleeps in house?
No
Yes
Sleeps on bed
No
Yes
Sleeps on Furniture
No
Yes
Reason for turning the dog in to rescue and any other important information
Gets along with children ?
No
Yes
Gets along with Cats?
No
Yes
Gets along with other dogs
No
Yes
If NO - Please explain
Has Dog ever attempted to bite, bitten or attacked another animal, person or child ?
No
Yes
If yes, please explain:
Physical and Medical Care
Breeder's Name
Vet's Name
Vet Phone
Shot Record
No
Yes
Wormed?
No
Yes
On Heartworm Preventive?
No
Yes
Vitamins?
No
Yes
Vitamin Brand:
Tick/Flea Treatment
No
Yes
Brand used most often:
Currently under medical treatment for:
Medications and Dosage:
Microchiped?
No
No
Yes
Unknown
It is understood that Schnauzer Love Rescue, Inc. does not buy or pay for dogs. This is a service to help place Schnauzers in new homes when their present owners can no longer keep them.
This service is free, however a donation to help pay for expenses would be appreciated.
Please read, sign and date the following:
I,
the undersigned, hereby IRREVOCABLY surrender to the Schnauzer Love Rescue, Inc. for placement and adoption, the
Schnauzer, named
I hereby represent and warrant to said Rescue, their agents, successors and assigns that the undersigned are the sole owner of the above described Schnauzer. That I have full power and authority to surrender this animal for adoption, that I am the only person who is listed as registered owner of this animal with the AKC, that no other person or persons' have any legal or equitable ownership interest in this animal. I certify that this dog is not possessed of an dangerous or vicious 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 Schnauzer Love Rescue, Inc., 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. I agree to indemnify and hold harmless Schnauzer Love Rescue, Inc. for any damages suffered and expenses incurred (including legal fees) in defending any legal action, whether for bodily injuries or death, property damage, breach of contract, or otherwise, whether instituted by us or by any other person or persons including the adoptive owners, arising out of or in consequence of the placement of the Schnauzer, in reliance on the authorizations, representations and warranties we have made in this agreement. I also agree to provide Schnauzer Love Rescue, Inc. with any documents and all other available information concerning this Schnauzer which might assist in matching this Schnauzer with the proper prospective adoptive home, including health and shot records, pedigree, name and address of breeder or other person from whom the dog was acquired, and information concerning this Schnauzer's ; dog history, such as important life events and individual personality quirks.
By executing this document, I understand that I am giving up forever all right, title and interest to the above mentioned Schnauzer. I further understand that all future decisions regarding the placement of this animal will be made solely by Schnauzer Love Rescue, Inc. I also understand that if this Schnauzer is later found to have such an unpredictable temperament as to be unsuitable for any placement, or if the animal's quality of life is substantially impaired, in the opinion of a competent veterinarian, by a chronic, irreversible, painful condition, euthanasia may be considered as a final alternative to adoptive placement.
I understand that Schnauzer Love Rescue, Inc. may contact the breeder or previous owner of the Schnauzer to provide additional background information, or otherwise assist in locating a suitable adoptive home and hereby give my consent to these efforts. 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. This is a legally binding document for the IRREVOCABLE SURRENDER of your Schnauzer for placement to an adoptive home.
Please read carefully and completely before signing.
I have read the preceding and agree to the conditions
set forth this
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