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WESTIE RESCUE DOG RELEASE FORM

Please fill out what you can below in order to help us give your dog the best medical care and training possible. The more detail you can provide, the more you are helping us in finding the best possible permanent home for your dog.

Valid Format: mm/dd/yy

 

RELINQUISHING PARTY INFORMATION

Numeric Only

Valid Format: (999) 999-9999 AnyAddress@yahoo.com

 

DOG INFORMATION

Invalid format.

 

DOG BEHAVIORS

Check all behaviors that apply:














 

VET INFORMATION

Valid Format: (999) 999-9999 Valid Format: (999) 999-9999

Invalid format.

 

CERTIFICATION

It is understood that WESTIE RESCUE HOUSTON does not buy or pay for dogs. This is a service to help place Westies in new homes when their present owners can no longer keep them. A donation to help pay for expenses is appreciated. Donations are tax deductible and can be mailed to the address at the bottom of the form.

I A value is required., hereby release and make available for adoption, the dog named A value is required. , to WESTIE RESCUE HOUSTON. I certify that I am the owner of this dog, free and clear of all other interests. I certify that this dog is not possessed of any dangerous or vicious propensities, and that I have not willfully concealed information about the dog that might indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify WESTIE RESCUE HOUSTON and its agents from all claims, demands, actions, causes of action, or liability of any kind whatsoever arising as a result of, or in connection with, the adoption or other disposition of the above named dog. I authorize the Veterinarian's office(s) listed above, to release any medical records of the dog mentioned above, to WESTIE RESCUE HOUSTON, and/or its Assigns and agree to allow them to discuss the medical records of this dog with representatives of WESTIE RESCUE HOUSTON and/or its Assigns and with any future Veterinarian's office to the extent that it is for the express benefit of the dog's health and well being.

Signed By Owner/Releaser: A value is required. Invalid format.A value is required.

 

ACKNOWLEDGEMENT

Westie & Scottie Rescue Houston
PO Box 9776
The Woodlands, TX 77387-9776
855-468-7974

If you have printer access, please print this form and bring with you to the Release Meeting. Double check all fields have been printed properly. If not, make corrections by hand. Printing/Saving to a .pdf format should preserve all form data.

Westie Rescue Houston, a 501(c)3 Non-Profit Organization ~ 2011