The grass is Always Greener on… theothersideofthefence.org, a non-profit corporation dealing with the prevention of cruelty to animals and global education EIN #86-1174463 CHARTER #N00932776 520 CR 5351 Poplar Bluff, Mo. 63901 Phone- 573-686-7551 Fax- 866-240-8070 jaymeeyh@theothersideofthefence.org www.theothersideofthefence.org/ RELEASE CONTRACT I, ________________________________Hereby relinquish all ownership rights of animal(s) known as, ______________________________sex ___________, age,_________ to theothersideofthefence.org this date, ______________________. theothersideofthefence.org requires a $30.00 release fee for this animal. This fee helps to cover the spay/neuter, vaccinations, food, boarding, and other expenses incurred for the welfare of this animal. This is a very fair price considering all the money and time that we will spend on finding this animal a more compatible home. PLEASE FILL OUT THE FOLLOWING SECTION Dog's date of birth: _________________ Breeder, if known: _____________________________ Does the dog like: [] Other Dogs [] Children [] Riding in the car [] Water [] Cats []Playing Ball [] Walks [] Strangers [] Other Has the dog been: [] Tied [] Loose [] House dog [] Yard all the time [] Doghouse [] Chained [] Beaten [] Loose in the yard [] Kenneled [] Garage [] Basement [] Yard part time Habits: [] Housebroken [] Used to collar and leash [] Gets out to follow children [] Howling [] Destructive [] Walks nicely on leash [] Jumps on people [] Runs [] Barking [] Pulls on leash [] Jumps fences [] Digging [] Vindictive [] Finicky eater [] Escape artist [] Chewing [] Gulps food[] Tricks/other Temperament: [] Friendly [] Anxious to please [] Very Trainable [] Obedient [] Enthusiastic [] Happy-go-lucky [] Hyper [] Reserved [] Outgoing [] shy [] Un-trainable [] stubborn [] Suspicious [] Protective [] calm [] Lethargic [] Cautious [] Timid [] Adaptable [] Inflexible Can you add anything to describe the dog's general temperament? ______________________________ ___________________________________________________________________________________________________________ Has the dog ever bitten a person? [] Yes [] No Who/What_____________________________________________________________________________________________ Has the dog ever killed another animal? [] Yes [] No When/Why?____________________________________________________________________________________________ Physical Appearance: Color:___________ Size: [] small [] Medium [] Large Eyes: ____________________________ Other: ______________________________ Medical History: Veterinarian: _______________________________ Shot Dates: Address: ____________________________________ DHLP: _____________________ Phone: _________________________ Parvo ______________________ Deworm, date ____________________ Rabies 1 yr 3 yr Other Medical History: (Illness, allergies, injuries, physical problems) Food and Medication: __________________________________________________________ Type of food: ___________________ Number of feedings per day: _____ Amount: ______ Type of medication: ___________________________________________ Dosage: _______ Reason for giving dog up: _________________________________________________________ Grace Period: There is a grace period of 3 (three) days should the owners/releasers change their mind and wish to reclaim the above-mentioned dog. If the dog is reclaimed, there will be a boarding fee of no less than $15.00 per day, plus any veterinary expenses including spay/neuter and any additional expenses incurred during the course of the dogs stay with theothersideofthefence.org. If you wish to have your rights to the 3 (three) day grace period, please sign directly below. By NOT signing below, it is hereafter understood that all rights of ownership to said dog are relinquished to theothersideofthefence.org. Signature ________________________________________ Date ________ Witness _____________________________________ Attorney Fees and Costs: Should it become necessary for theothersideofthefence.org to take legal action to defend itself or otherwise enforce the provisions of this Contract, the Undersigned Releasers agree to pay all court costs and reasonable attorneys fees. The place of venue shall be Poplar Bluff, Missouri. ______________ (Initial) Print Name: ___________________________________________ Date: ______________________________________ Signature: _____________________________________________ Address: ________________________________________________________________________________________________ Phone (work): ________________________________________ (home): ____________________________________ Witness: _______________________________________________