Create Account or Log In:
Creating an account or logging in via facebook/email will let you save your application, and allow you to access your pets medical records and other important information after you adopt or foster.
Dog’s Name:
Breed:
D.O.B. / Age:
Color:
Sex:
Up to date on vaccinations?
Can you provide us with a copy of the veterinary records?
Can you attach Veterinary Records?
If you cannot give us a copy of the veterinary records please list the contact information for your vet: Name, phone number. Please indicate if dog's records would be under a different name.
Can you attach a photo of the dog? Photo 1
Photo 2
Photo 3
Do you want to be kept in the loop during the re-homing process?
Do you want us to share your contact information with the dog's future owner?
Reason for surrendering animal.
My signature below certifies that I am the owner of, or have the authority to surrender to Nerdy Paws Animal Rescue, the animal described above. I hereby relinquish all rights of ownership and any right to information on the disposition of said animal. I also authorize the release of any veterinary records regarding the animal. I certify that to the best of my knowledge I have disclosed all information about the animal concerning health, behavior, history and anything else that may affect the safe placement of the animal in a new home, and that all statements made above are true and correct.
Signature:
Date:
Create Account or Log In:
Creating an account or logging in via facebook/email will let you save your application, and allow you to access your pets medical records and other important information after you adopt or foster.