Relinquishment Form -

Animal Relinquishment Form

I am the legal owner of this dog listed below.
I am relinquishing my rights to this dog and signing this dog over to Tobie’s Small Dog Rescue.

Your Name

First

Last

Dog Name

Age

Weight

Breed

Color

Gender

Male
Female

Is the dog spayed or neutered?

Yes
No
Unknown

Is the dog up-to-date on vaccines?

Yes
No
Unknown

Microchip

Driver license number or State ID

Reason for relinquishment

Details about the animal, temperament, etc

Veterinarian that has treated this dog

By Agreeing Below, You Are Transferring Ownership To Tobie’s Small Dog Rescue. Please, Attach A Copy Of Any Medical, Licensing Or Proprietary Records You Have For This Dog.

I Agree

Date

Cell / Work Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Upload current photo of your pet

Drag & Drop Files, Choose Files to Upload

Max file size 10Mb – Allowed File Extension .png, .gif, .jpeg, .jpg, .pdf