RELEASE OF PET OWNERSHIP

I, ____________________________, as full owner(s), hereby donate the _____________ known as

________________________________________, age __________ , sex ___________ to the pet adoption person represented by the undersigned. I certify that this transfer has agreed to by all co-owners. I hereby transfer full ownership, rights, and responsibility as of the above date.

Owner: ___________________________ Co-owner: ________________________________

Address: __________________________ Address: _________________________________

City: ____________ State: __ ZIP:______ City: ___________________ State: __ ZIP: _______

Phone: ____________________________ Phone: ___________________________________

Signature: __________________________ Signature: _________________________________

Pet Adoption Representative: ______________________Signature:_______________________

PLEASE FILL OUT THE FOLLOWING:

Species:____________________________ Breed or Type: ____________________________

Physical Appearance: ___________________________ Color: _________________________

Registration: _____________ ___________ Facial Markings: ___________________________

Tattoo: ____________________________ Scars or broken teeth: _______________________

MEDICAL:Shots:__________________ Allergies? _____________ Spayed/Neutered? _____

Veterinarian: _________________________________ Phone: _________________________

Does the pet like:Strangers? ________ Children? _______ Cats? _______ Dogs? _________

Play? ________Car rides? ______ Toys? _________ Other? __________________________

HABITS: Housebroken? ________ Chewing? __________ Escape house or fence? _________

Digging? ______________ Tricks? ______________________________________________

TEMPERMENT: _________________________________________________________

Has the pet ever bitten anyone (Y/N)?: ___ Who? _______________ When? ______________

Why? ___________________________ Seriousness of bite? __________________________