Name of Dog: Age of Dog: Colour of Dog: Weight of Dog: Sex of Dog: Male Female Has the dog been Altered? Yes No Rabies Date: MM slash DD slash YYYY DHLPP Date: MM slash DD slash YYYY Bordatella Date: MM slash DD slash YYYY Heartworm Preventive Date: MM slash DD slash YYYY Flea Preventive Date: MM slash DD slash YYYY Explain Current Health Problems:Explain any medications the dog is currently taking:Is your dog good with children?YesNoIs your dog good with cats?YesNoIs your dog good with other dogs?YesNoDoes your dog like to swim?YesNoDoes your dog like to ride in cars?YesNoDoes your dog walk well on leash?YesNoWhere does your dog sleep at night?First ChoiceSecond ChoiceThird ChoiceWhere does your dog stay during the day? Does your dog jump fences?YesNoDoes your dog come when called?YesNoIs your dog house-broken?YesNoIs your dog crate-trained?YesNoDoes your dog have separation anxiety when left alone?YesNoDoes your dog growl at strangers?YesNoWill your dog let you take food or toys away?YesNoDoes your dog know any of the following commands? Sit Down Stay Fetch How does your dog behave while being groomed? How does your dog behave while being bathed? How does your dog behave while being brushed? What do you enjoy the most about this dog? What do you enjoy the least about this dog? What would be the ideal home for this dog? Relinquisher's Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone/CellularEmail Has your dog bitten anyone?YesNoHas your dog bitten another dog?YesNoPlease describe the bite circumstances.IMPORTANT NOTICE: All relinquishers of the above-named dog must agree to this contract before Monty’s Mutts Dog Rescue will agree to take this dog. In regard to the surrender of the above-described dog, I/We, the undersigned, agree to the following conditions: 1. I certify that I am the rescuer/relinquisher of this dog. 2. I understand that this dog becomes the responsibility of Monty’s Mutts Dog Rescue and that I have no further rights to this dog. 3. All decisions regarding the placement of this dog will be made solely by Monty’s Mutts Dog Rescue. 4. The Relinquisher has no rights to information regarding the adoption of this dog. Updates on the dog can be provided by Monty’s Mutts Dog Rescue from time to time. Consent(Required) I consent to relinquish this dog..
