Basset Hound Rescue League, Inc.(BHRL)
P. O. Box 44201
Fort Washington, MD 20744
Phone- 301-292-3020 /Fax- 301-292-1555 /email- wrdcld@cs.com
Pet Relinquishment Form
I do hereby transfer ownership of the below described dog. I either own or have the legal right and authority to sell or otherwise release to Basset Hound Rescue League (hereafter BHRL), to be adopted into a new home or otherwise handled as BHRL, in its sole discretion, shall deem best. I also agree to surrender with described dog all medical/veterinary records pertaining to said dog. I do realize that if said dog is for any reason unfit for adoption (i.e., too ill, too old, poor temperament, etc.) it will be humanely euthanized with a designated volunteer of BHRL present to comfort and ensure it is done properly and humanely.
I do futher release BHRL and any person who may obtain the possession or ownership of said dog through BHRL, from any kind of claim arising out of my title to or control of such animal.
I hereby acknowledge that I have read and understand the above conditions and all information provided is true, complete and correct.
Name of owner(s) of below described dog (please print):
_____________________________________________________________________
Street Address:__________________________________________________________
City:__________________________________ State______________ZIP:__________
Day phone:________________________ Evening phone:________________________
Dog's name:_____________________ Sex: M____ F____ Age/DOB:_______________
Breed:__________________________ Color/Markings:___________________________
Any previous names:________________________________________________________
Why is the dog being given up?_____________________________________________
___________________________________________________________________________
Dog was acquired by me from: Shelter____ Breeder____ Stray____ Other___
Is the dog spayed/neutered? ___________
Tested for heartworm? __________ Date of test:__________ Result:__________
Is the dog currently on Heartworm preventative?_________ Brand:_____________
Innoculations/Dates: DHLPP_____________________
Rabies____________________ Tag #:________________
Other medication:______________________________________________________
Name and location of veterinarian:_____________________________________
Is the dog housetrained? If no, please explain _____________________________
____________________________________________________________________________
Has the dog ever bitten anyone? __________
If yes, complete the Bite Disclosure Form,
and send with the Pet Relinquishment Form.
I hereby acknowledge that I have read and understand the above terms and conditions, and that all information provided herein is complete and correct.
Name (print):_____________________________________________________
Signature:________________________________________________________
Name of BHRL Agent:_______________________________________________
Sinature of BHRL Agent:___________________________________________
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