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Owner Surrender/Shelter or Rescue Transfer Form

Please note- Once you start if you leave this page, your information will not be saved and you will have to start over!

Pick ONE
Multi-line address
Spayed/Neutered?
Spayed
Neutered
Not fixed
Is the dog on any medications?
Yes
No
Is your dog microchipped?
Yes
No
Have you reached out to the breeder to see if they will take their dog back?
Yes
No
Please list all training that dog has (select all the apply):
Does the dog have a Human bite history?
Yes
No
Would the dog do best as an only dog or with another dog
Has your dog been around Cats?
Yes
No
Can the dog go to a home with cats?
Yes
No
Doesn't matter
Has never been around a cat, so don't know
Has the dog been around kids? (please select all that apply)
Do you understand that by filling out this form, does not guarantee the rescue will take in your dog or has an immediate placement option for your dog?
Yes
No

By signing below, you confirm that you are the current legal owner of this dog. If arrangements are made for the above-named dog to be removed from your care with the assistance of Paws to Peaks Rescue and placed into a foster or adoptive home, you hereby transfer ownership of the dog to Paws to Peaks Rescue

By signing below, you grant Paws to Peaks Rescue to give above-named dog any medical treatment deemed necessary, and should a veterinarian determine above-named dog is too ill to be treated, I give Paws to Peaks Rescue the right to put said dog humanely to sleep. I release the above-named rescue from all liability concerning said animal.

BY SIGNING BELOW, I HEREBY STATE THAT I AM GIVING UP MY DOG OF MY OWN FREE WILL

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