Surrender Form | Hair Of The Dog

Name*

First Last

Address*

Street Address Address Line 2 City State Zip Code

Email*

Phone*

Dog's Name*

Dog's Gender*

Dog's Age/DOB*

Neutered/Spayed?*

Yes
No

Identifying Characteristics*

Health Issues*

Behavioral Issues*

Bite History*

Bite Circumstances*

Explain any special care needed*

Please Check All Applicable*

Friendly towards other dogs
Friendly towards cats
Friendly towards children

Date of Last Flea/Tick Prevention*

Date of Last Heartworm Prevention*

I, owner of dog named above, hereby voluntarily relinquish all claims and ownership of said dog to the organization known as Hair of the Dog Rescue Inc. (hereinafter known as HOTD) and members thereof. I understand that I cannot reclaim this dog once it is in the possession of HOTD. I also agree to give HOTD all of the dog’s registration papers, license, microchip number and veterinary records.

Owner Signature*