Owner Relinquishment

Golden Bone Rescue & Rehab
PO Box 2547 - Sedona, Arizona 86336
First Name:
Initial
Last Name:
Email address:
Pets Name:
State and Drivers License Number
Street Address:
City
State
Zip
Pets Breed:
Home Phone:
Cell Phone:
Work Phone:
Name of your veterinarian or animal clinic
Phone number and address of your veterinarian or animal clinic
 I hereby authorize the veterinarian named herein to release information about me or my pet(s) to Golden Bone Rescue & Rehab as necessary to evaluate this application.
PLEASE FILL OUT THE FOLLOWING SECTION to help us place your dog. Check all that apply. Add any helpful information where you can.
Socialization
Does the dog like:
Has the dog been
Other information about your dogs socialization skills and preferences:
other dogs
housedog
cats
crated
children
tied
walks
chained
other dogs
loose in neighborhood
strangers
dog house
play
yard at all times
riding in the car
yard part time
other
other
Habits
What signals does your dog know?
signals to go out
house trained
howling
escape artist
runs
digging
Other information about your dogs habits and behaviors:
jumps on people
barking
finicky eater
jumps fences
used to collar/leash
chewing
walks nicely on leash
destructive
gets out to follow children
vindictive
tricks
gulps food
Titles?
Training?
Temperament
Has the dog ever bitten a person? 
If yes, explain:
protective
friendly
enthusiastic
very trainable
anxious to please
obedient
Action taken?
hyper
happy-go-lucky
suspicious
untrainable
Can you add anything to describe the dog's general temperament?
cautious
chewing
aggressive
calm
shy
adaptable
reserved
stubborn
lethargic
inflexible
Physical Appearance
Color
Size
Age
Medical History
Name of your veterinarian or animal clinic
Phone number and address of your vet
List shots
Rabies shot?
When?
Date?
Expires?
Rabies shot done by?
    Heartworm test?
Date?
    Results?
On preventative?
If this dog is on heartworm preventative what dose / brand?
Fecal exam date:
Results?
Spayed / Neutered
Date:
AKC Paperst?
AKC Number
Other medical history (illness, allergies, injuries, physical problems):
Food & Medication
Type of food, number of feedings per day and amounts?
Type of medication and dosages?
Items given with dog
Describe toys:
toys
leash
Describe food:
blanket
food
collar
crate
Please feel free to provide any other information you feel is important:
Donation:
I would like to donate the following amount to Golden Bone Rescue & Rehab towards the care and placement of my dog.
Digital Certification
I digitally certify that I am the sole and legal owner of this dog and hereby surrender to Golden Bone Rescue & Rehab this dog  I hereby turn over full ownership and responsibility as of this date.  I understand that the contract is effective immediately from this date submission. I also understand that with this instrument the dog becomes the property of Golden Bone Rescue & Rehab.
Yes.
I agree.
Dog Owners Name
Witness
Date
Must be submitted by owner before we will accept the dog into our program. Please be sure you are serious about relinquishing your dog before involving the program's time and energies.
Thank you for entrusting your precious dog to our rescue program so that he or she may have a new life.  We realize there are many good reasons for relinquishment and respect those decisions.  Giving your dog this opportunity is an act of love, and you are definitely doing the right thing.  Some owners fear that we will put down their dogs when they come into rescue.  Please rest assured: we are a dedicated "no kill" rescue program for dogs who need us, and we love all our dogs.  Our mission is to care for your dog, and find him or her the best family possible for a great match.