Belgian Tervuren Rescue, Inc.
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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
When with people, is this dog....
Shy
*
Yes
No
Aggressive
*
Yes
No
Friendly
*
Yes
No
Gets along well with...
*
No Children
Children over age 5
Children of all ages
Unpredictable
*
Yes
No
When with other dogs, is this dog...
Shy
*
Yes
No
Friendly
*
Yes
No
Aggressive
*
Yes
No
Unpredictable
*
Yes
No
When with other domestic animals, is this dog...
Shy
*
Yes
No
Friendly
*
Yes
No
Aggressive
*
Yes
No
Unpredictable
*
Yes
No
Does this dog....
Chase cats, other dogs, livestock, etc
*
Yes
No
Jump or climb fences
*
Yes
No
Open gates
*
Yes
No
Dig holes
*
Yes
No
Chase cars
*
Yes
No
Bark excessively
*
Yes
No
What behaviors does the dog display to indicate stress?
*
Is the dog afraid of anything? If so, what?
*
Training
Is this dog crate trained?
*
Yes
No
Is this dog leash trained?
*
Yes
No
Is this dog house broken?
*
Yes
No
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
Home
About
About Tervuren
Frequently Asked Questions
Who We Are
Forms
Adoption
Adoption Process
Available Dogs
Volunteer
Success Stories
Need help?
Donate
Contact