Relinquish (old)

Relinquish a Dog

Please fill out the form below, or download a PDF.

Description of the Dog

* Indicates required field

Call Name *

Registered Name (if available) *

Age *

Date of Birth (if known) *

Sex *

Male Female

Tattoo/Microchip (if available) *

AKC Number (if available) *

Breeder's name (if known) *

Health Information

Veterinarian *

Address *

Vet's Phone Number *

Date of last Rabies vaccination *

Date of last Distemper vaccination *

Date of last Parvo vaccination *

Is this dog dysplastic? *

Yes No

Is this dog epileptic? *

Yes No

Is the dog on heartworm medication? *

Yes No

Last dose of heartworm medication and brand of medication *

Is the dog on flea/tick preventative? *

Yes No

Date of last dose of preventative and brand *

Please list any allergies *

Please list any other medical problems *

If medications are required, please include reason needed, name and strength of medication, when and how often given and how long the dog has been on the medication, veterinarian if not prescribed by the veterinarian listed above. *

Was this dog ever bred? *

Yes No

If bred, how many times? *

Is this dog spayed/neutered? *

Yes No

When was the dog spayed/neutered? *

What dog food are you feeding? List number of feedings per day and amount. *

Temperament

With people, is this dog: *

Shy Friendly Aggressive Unpredictable

Gets along well with *

Children over age 5 Children under age 5 No Children

With other dogs, is this dog: *

Shy Friendly Aggressive Unpredictable

What behaviors does the dog display to indicate stress? *

Is the dog afraid of anything? If so, what? *

Training

Is the dog *

Crate trained Leash trained House broken

What are the dog's bathroom signals? *

What commands does the dog respond to? *

What are the dog's favorite activities and/or toys? *

Choose the relinquishment that describes this situation:

Legal Owner

Person who found the dog

I certify that I am the legal owner of the above-described Belgian Tervuren and have no unfulfilled contractual obligations concerning this dog. I hereby transfer ownership of this dog to Belgian Tervuren Rescue, Inc. and do relinquish any and all claim to this dog. Any health and registration records or papers for this dog will be promptly turned over to Belgian Tervuren Rescue, Inc. I agree that this dog may be disposed of at the discretion of Belgian Tervuren Rescue, Inc.

I certify that I am the finder of the above-described Belgian Tervuren. I hereby relinquish any and all claim to this dog. I agree that this dog may be disposed of at the discretion of Belgian Tervuren Rescue, Inc.

Date of possession: *

Location where the dog was found (city/state) *

I am the: *

Legal Owner Finder of the dog

Your Name *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email address *

Submit