Rehome a pet

Today's Date

Name

Email Address

Home Phone

Other Phone

Street Address

City

State

Zip Code

Name of Pet

Reason for giving up animal

Pet Birth Date (if known) or age

How long has the pet lived with you?

Sex of Pet Sex of Pet Male - not neutered Female - not spayed Male - neutered Female - spayed

Animal is/has... (check all that apply) Animal is/has... (check all that apply) Inside pet Outside pet Chained outside Fenced yard Dog run Runs loose Crate trained Housebroken Mean Sweet Timid Agressive Loves cats Hates cats Loves dogs Hates dogs Picky eater Eats anything Likes grooming Hates grooming Rides well in car Rides bad in car Runner Walks off lead

What bad habits does this pet display?

What are the pet's best qualities?

Has the pet ever bitten anyone? Has the pet ever bitten anyone? Yes No

What training has the pet had?

If yes, under what circumstances?

Name of your current vet

Phone of your current vet

Vet Street Address

Vet City

Vet State

Vet Zip Code

Date of last: DHLP-P

Date of last: Parvo/Corona

Date of last: Bordetella

Date of last: Rabies

Date of last: Heartworm Test

Date of last: Fecal Exam

RV#

License#

Current Medications Current Medications Heartworm Other

Any health problems?

I, the undersigned, certify ownership of the dog described above. I certify that this dog has not bitten any person or animal within the last 10 days, and has not been exposed to rabies. I give complete ownership of the dog to Perry Animal Welfare Society releasing its representative from all liabilities of said dog. I, the undersigned, certify ownership of the dog described above. I certify that this dog has not bitten any person or animal within the last 10 days, and has not been exposed to rabies. I give complete ownership of the dog to Perry Animal Welfare Society releasing its representative from all liabilities of said dog. I agree to these terms