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Owner Surrender/Rehoming Form
Rehoming Application request
Step
1
of
4
- Personal Information
25%
You The Owners Full Name
*
First
Last
Phone
*
Email
*
Address
*
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Armed Forces Americas
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Where are you located?
About The Dog
*
Dogs Name
Breed
Approx Weight
Age
Information the dog
Where did you obtain this Dog?
*
Was it a rescue? Shelter? Breeder?
Is your Dog good with?
*
Cats
Small Dogs
Big Dogs
Children
Other Animals
None or unknown
These questions are for our information and foster placement please be honest with your answers.
Medical Questions
Is the Dog Spayed or Neutered?
*
Yes
No
Do you have Copies of it's vaccination records, and are they up to date?
*
Yes
No
Photos/Documents of Vaccination Records
Drop files here or
Select files
Accepted file types: jpg, png, pdf, gif, jpeg, , Max. file size: 50 MB.
Please upload any photos or PDF scans of your dogs vaccination records and spay or neuter certificate.
Does it have a Microchip?
*
Yes
No
We will need to have you transfer ownership for our registration.
Does your dog have special medical needs?
*
Yes
No
Medical needs such as diabetic, epileptic, food allergies, any incurable dieses that need to be treated to maintain quality of life.
Medical Needs:
*
Reason for Wanting to Rehome your Dog
*
Indicate your reason(s) for wanting to rehome your dog.
Additional Information
Anything about your dog we should know? Personality quirks? Tricks? Commands? Help us help find your dog the ideal home.
Photo of your Dog
Drop files here or
Select files
Accepted file types: jpg, png, pdf, gif, jpeg, , Max. file size: 50 MB, Max. files: 3.
Please upload a photo of your Dog
Do you agree to the following
*
I agree to the following
I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this Owner Surrender Form, hereinafter referred to as “the animal.” I hereby surrender any and all property rights of the animal. I release and discharge Hearts 4 Paws from any and all claims, obligations, liabilities, and causes of action whatsoever arising out of or relating to the ownership, possession, or disposition of the animal(s) and agree to hold harmless Hearts 4 Paws from and against any and all such rights claims, obligations, liabilities and causes of action which may be asserted by other parties. I certify that no other person has a right of property to the animal. I understand that by surrendering my property rights to the animal, the animal may be transferred into the custody of Hearts 4 Paws. I also hereby certify that the animal has not bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the animal, the animal will not be available to be returned. I further certify that I have read and understand the terms of this Owner Surrender Form.
Owner's Signature
To be Signed at time of Surrender.
Todays Date
*
MM slash DD slash YYYY
For legal records.
Donation Amount for surrender
If you would like to place a monetary donation with the surrendering of your animal it would be greatly, this would only be requested on accepting your animal into our program.
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