Fox Terrier Rescue of Colorado

Release of Ownership Form

Directions:

Please read all information on relinquishing a dog before submitting this form.

Complete all items on this Release of Ownership form.

Click the button at the end to send it to us.

Thank you!

Fox Terrier Rescue of Colorado respects your privacy -
we do not sell or release your personal information.

Owner/Co-Owner Contact Information

Owner's Name
Street Address
City
State
Zip Code
Phone
Alt. Phone
E-mail Address
Co-Owner’s Contact Information, if applicable:
Co-Owner Name
Co-Owner Phone
Co-Owner Alt. Phone

Dog Information/Background

Breed:

Sex: Male Female

Altered: Yes No

AKC Registration #:

Other Registry and #:

Color:

Age:

Dog’s Registered Name (if applicable) or breeders name and address if known:

Shot Record - Test History

Check vaccinations received:

Diptheria Leptospirosis Hepatitis Parvovirus Parainfluenza

Vaccination Date(s):

Rabies Vaccination Date:
Bordatella Vaccination Date:

Worms
Date last tested:
Date last given treatment and type:

Heartworm

Date last tested:
Date last given preventative and type:

Lyme Vaccination Date:
Ehrlichia Test Date:

Name, address, and phone number your veterinarian:

Brand(s) of Dog Food/Treat(s) used regularly:

Feedings per day:

Dog Behavior/Training

Housetrained: Yes No

Crate Trained: Yes No

Obedience Trained: Yes No

Leash Trained: Yes No

Barker: Yes No

Digger: Yes No

Dog Aggressive: Yes No

Fence Jumper: Yes No

Ride well in car: Yes No

Chew furniture/shoes/clothing: Yes No

Does the dog sleep:

In the house: Yes No

On a bed: Yes No

On furniture: Yes No

Does the dog get along with:

Cats: Yes No

Dogs: Yes No

Other Animals: Yes No

Has the dog ever attacked an animal: Yes No

Or attempted to: Yes No

Has the dog ever bitten a person? Yes No

Or attempted to: Yes No

If “yes” to any above, explain in detail:

Dog's Behavior With Children (Describe in detail for those under 8 and over 8 years old):

To assist us in placing your dog, please tell us about any other special likes, traits or problems with normal daily life that your dog has. These can be “cute” habits or things about which you think new owners would need or like to know. For example, if the dog really enjoys playing ball, likes or dislikes playing in water or bathing, or is really frightened of certain noises like vacuums or motorcycles or garbage trucks, tell us those things and others like them.

Agreement

By checking this box, I agree to the following:

1. I/we hereby make available for adoption, the Wire Smooth (check one) Fox Terrier called by the name , to Fox Terrier Rescue.

2. I/we certify that I/we are the owner(s) of this dog, free and clear of all other parties.

3. I/we certify that this dog is not possessed of any dangerous or vicious propensities, and that I/we have not willfully concealed information about the dog that might indicate such propensities.

4. I/we certify that the information I/we have provided about this dog is true and complete.

5. I/we hereby forever release, discharge and agree to hold harmless and indemnify Fox Terrier Rescue, and any agent thereof, from all claims, demands, actions, 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.

6. I/we agree my/our name(s) and phone number(s) may be released to the new owner(s) of this dog and that the new owner(s) may contact me/us to discuss this dog.

Owner Signature/Name:
Date:

Co-Owner Signature/Name:
Date: