This Agreement to Transfer Ownership of Dog (“Agreement”) is entered into on this __________ day of ___________, 201__.
I, _____________________________ owner of the below described Dog, do hereby permanently and irrevocably transfer ownership of the dog to Small Paws® Rescue, Inc. By executing this Agreement, I acknowledge that I am irreversibly relinquishing to Small Paws® Rescue, Inc. any and all right, title, and ownership that I had or may have had with respect to the Dog. I further acknowledge that I am the owner of the Dog and that I am fully authorized to enter into this Agreement.
Description of Dog:
Breed: __________________Registration #:________________
Tattoo #_________________Microchip #: _________________
Other identifying characteristics:
Name and address of breeder if known:_______________________________________________
Diet Dog has been receiving:_____________________________________________
Has Dog Ever Bitten Anyone?______________________________
Good with children?_____________________________________
Good with cats?____________ Good with other dogs?__________
Date of last rabies immunization?____________, heartworm test:____________, DHLPP:_______
Name and telephone number of Veterinarian who has cared for this dog?_________________________________________________
Reason for release of Dog to Small Paws® Rescue, Inc. _____________________________________________________
Amount of donation, if any, coming with Dog into rescue, to help defray costs for care, until adoption $____________.
By signing this Agreement, I acknowledge that I have read the Agreement and that it is a binding legal agreement.
I, a representative of Small Paws® Rescue Inc., hereby do accept responsibility for the above named and described Dog on behalf of Small Paws® Rescue, Inc.
Signature of Small Paws® Rescue Volunteer or Staffer