Precious Paws Rescue, Inc.®

  Owner Release Form

ID #__________         Name: __________

 Description:  _____________________________________________________________

                         ____________________________________________________________

 Purebred:                     [       ]   Yes      [     ]   No

 Sex:                            [       ]   Male    [     ]   Female

 Altered:                       [       ]   Yes      [     ]   No

 Vaccines Current:          [       ]   Yes      [     ]   No

 HW Status:                  [       ]   Pos      [     ]   Neg       [     ]   Unknown

 Health Status:   ___________________________________________________________

                         ____________________________________________________________

Has this pet ever bitten anyone?            [       ]   Yes      [     ]   No         [        ]  Don’t Know

Snapped at anyone?                             [       ]   Yes      [     ]   No         [        ]  Don’t Know

Is this pet primarily kept?                      [       ]   Inside   [     ]   Outside  [        ]  Kennel

Is this pet housetrained?                        [       ]   Yes      [     ]   No         [        ]  Don’t Know

Good with kids?                                   [       ]   Yes      [     ]   No         [        ]  Don’t Know

Good with other dogs?             [       ]   Yes      [     ]   No         [        ]  Don’t Know

Good with cats?                                   [       ]   Yes      [     ]   No         [        ]  Don’t Know

Has this pet seen a vet regularly?           [       ]   Yes      [     ]   No         [        ]  Don’t Know

Been vaccinated regularly?                    [       ]   Yes      [     ]   No         [        ]  Don’t Know

On monthly HW prevention?                 [       ]   Yes      [     ]   No         [        ]  Don’t Know

Was this pet found as a stray?               [       ]   Yes      [     ]   No         [        ]  Don’t Know

Purchased from a breeder?                   [       ]   Yes      [     ]   No         [        ]  Don’t Know

Have Registration papers?                    [       ]   Yes      [     ]   No         [        ]  Don’t Know

Been microchipped / tattooed?  [       ]   Yes      [     ]   No         [        ]  Don’t Know

Comments?      ____________________________________________________________

                        ____________________________________________________________

This pet is being surrendered by:

Name: __________________________________________

 Address: ________________________________________

 City, State, Zip: ___________________________________

 Telephone:   (______)  _______- ________

 SS# / DL# / OTHER ID:  ____________________________ 

 I hereby certify as follows  (please choose only one):

 (     )  I am the lawful owner of the animal being surrendered.

 (     )  I have been in custody of the animal being surrendered.

 (     )  I am the custodian of the animal being surrendered; I do not have any information as to whom the lawful owner may be; I found this animal running at large.

 BY SURRENDERING THIS ANIMAL, I TRANSFER ALL OF MY RIGHTS, TITLE AND INTEREST IN THIS ANIMAL AND RELINQUISH ANY AND ALL OWNERSHIP CLAIM TO THIS ANIMAL.  I UNDERSTAND THAT THE SURRENDER OF THIS ANIMAL IS FINAL AND IRREVERSIBLE.

 TO THE BEST OF MY KNOWLEDGE, THIS ANIMAL HAS NOT BITTEN ANY PERSON OR OTHER ANIMAL WITHIN THE PAST THIRTY (30) DAYS AND HAS NOT BEEN EXPOSED TO RABIES.

 I UNDERSTAND THAT PROVIDING FALSE INFORMATION TO THE QUESTIONS ABOVE IS UNLAWFUL.

 
 __________________________                               ______________________________
PPR Inc. Authorized Officer                                         Owner / Custodian

______________________________
Date of Surrender