PDF Release Form - Change of Ownership I do hereby release ...

[Pages:1]Release Form - Change of Ownership

I do hereby release ownership of my dog

to___________________________________________________________________

I understand that upon giving my dog to the above named person, that person becomes the sole owner of the dog. I will make no attempt to reclaim my dog. I fully grant this person the right to give my dog any medical treatment deemed necessary, and to possibly place the dog in a good adoptive home. Should a veterinarian determine my dog is too ill to be treated, if necessary, I give the above named person the right to put said dog humanely to sleep. I release the above named person from all liability concerning said animal, and the above named person will make every attempt to provide adequate care and find a permanent home.

I HEREBY STATE THAT I AM GIVING UP MY DOG OF MY OWN FREE WILL.

Dog's Name______________________________________________________________

Breed____________________________________ Color__________________________

Age_______________ Birthdate (if known) ______________________Sex___________

Owner's

info____________________________________________________________________

Name

Telephone number

________________________________________________________________________ Address, City, State, Zip

Current

Veterinarian______________________________________________________________

Name

Telephone number

________________________________________________________________________

Owner's Signature

Date

Thanks to JaneM and Collie Rescue of Greater Illinois for the original form this is based on.

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