Pug Pals Owner Relinquishment Form

Pug's Name

Male/Female

Age of pug

Spayed/Neutered

Rabies Tag Number

Vaccinations

Last visit to the veterinarian

What was the last vet visit for?

Is your pug microchipped?

Microchip company and number

How did you acquire this pug?

How long have you owned this pug?

Has this Pug had previous homes/How Many?

Reason for surrendering

There is nothing that will disqualify your pug from coming into the rescue. Please be totally honest.

Does this pug get along with dogs, cats, children, babies, toddlers, other household pets?

Have they ever snapped at or bitten anyone and what were the circumstances involved?

Is there anything your pug does NOT like?

What is your pug's temperament/personality?

Is this pug crate trained?

Is this pug housetrained?

Where is this pug used to being kept (indoors, outdoors, crate, etc.)

Is this animal used to being kept on/in (Please check all that apply)

What type of food have they been eating, how much and how often?

What type of training, commands or tricks do they know?

What are their favorite toys?

Where are they used to sleeping?

Current Veterinarian's Name, address and phone number?

Are you including a copy of their medical records?

What name are the medical records under?

Please detail any previous medical issues. (Remember to please be thorough and honest. Again there is nothing that will disqualify them from being accepted into rescue)

It is expressly understood by the parties to this Agreement that Relinquisher is the owner of said pug or has permission directly from the owner of said pug to voluntarily release the above name pug dog to the Group free and clear of any claim of ownership, and guarantees that no claim of ownership will ever be made against said dog.

Relinquisher represents and warrants that he/she is the sole owner of this dog and/or has the full complete legal right to relinquish said dog to the Group.

Relinquisher provides information regarding the temperament, behavior characteristics and any medical problems and treatments of the dog being released on the above sections of this form which shall be made part of this agreement and states that they are true and correct to the best of their knowledge.

Relinquisher further warrants that this dog has never bitten anyone unless disclosed above.

The Group agrees to hold Relinquisher harmless for any action of the dog after it is released to the Group unless there is an undisclosed history of aggressive episodes.

In the case of the above, the Relinquisher shall be solely and completely responsible for the actions of the dog prior to the date set forth in paragraph one above.

This agreement shall be governed by the laws of the State of Idaho and Utah and effective the date previously assigned above on this form.

Relinquisher's Signature

Please attach a photo of your pug here.

Please attach any medical records you have for your pug.