I, ________________________________Hereby relinquish all ownership rights of animal(s) known as, ______________________________sex ___________, age,_________ to The Other Side of the Fence this date, ______________________. On The Other Side of the Fence 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 O The Other Side of the Fence. If you wish to waive your rights to the 3 (three) day grace period, please sign directly below. By signing below, it is hereafter understood that all rights of ownership to said dog are relinquished to On The Other Side of the Fence.
Signature ________________________________________ Date ________
Witness _____________________________________
Attorney Fees and Costs: Should it become necessary for On The Other Side of the Fence 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: _______________________________________________
