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Basset Hound Rescue of Alabama
BASSET HOUND RELINQUISHMENT AGREEMENT
Name of
Releaser ___________________________________
(please print)
Rescue Dog Number_________________________________
Name:________________________________________________________________
Immunization Record:_____________________________________________________
Age:_____________ Color:___________________
Gender:____________________
Releaser releases the
above described animal to the Rescue Service and warrants that he has clear
title, free of any other claim.
As long as the animal remains in the possession of Releaser, Releaser
remains responsible for its actions and agrees to hold Rescue Service
harmless from any claims arising therefrom.
If the animal remains in the possession of Releaser until the Rescue Service
is able to place it in a suitable home, it is understood and agreed that the
dog is the property of Rescue Service, and that neither Releaser nor anyone
on his behalf shall take any action on behalf of the animal inconsistent
with the Rescue Service's ownership.
Releaser warrants that he
has fully and completely disclosed to the Rescue Service all information
known to Releaser concerning the temperament and behavior characteristics of
the animal being released. Releaser warrants that to the best of his
knowledge, this animal has never bitten any person, nor shown aggressive
behavior toward any person, nor had any serious medical problems, except as
follows:
Your help will be appreciated in completing the
following:
Neutered or Spayed? ________ Name of Veterinarian?
____________________________________
Heartworm test & result? _________ Date: _____ Preventative Used, if
any? _________________
Inoculations: (dates) DHLPP ________ Rabies ___________ Rabies Tag
# __________________
Medications:
_______________________________________________________________________
Preferences: ______________________________________________(men,
women, children, small children?)
Any bad habits? ____________________________________________(barking,
chewing, cats, other dogs?)
Signature(s) of Releaser(s): ______________________________________________
Address: ______________________________________________________
Phone: _______________________________________________________
Email: ________________________________________________________
Signature of Rescue Service Agent:
Date:
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