Rudy's Rescue Owner Surrender Form

OWNER SURRENDER FORM

After you fill out the form below, email the photos to dawgsrkids2@rochester.rr.com

or snail mail them to the physical address below.

The donation must be sent to the address below or can be made via Paypal at the link below,
or once you have submitted the form.

We do not accept any animals that are dangerous to the general public and reserve the right to ask
for a professional evaluation at the owner's expense. Additionally, surrendering your animal to rescue is not considered a donation.

PLEASE CONTACT YOUR VETERINARIAN TODAY. LET THEM KNOW YOU ARE RELEASING YOUR LAB TO RUDYS RESCUE. REQUEST THAT THEY MAIL THE ENTIRE MEDICAL RECORDS TO US AT THE ADDRESS BELOW. WE REQUIRE DOCUMENTATION FROM YOUR VETERINARIAN SHOWING YOUR DOG IS UP TO DATE ON VACCINATIONS -

Email: dawgsrkids2@rudysrescue.info

Mailing information:

RUDY'S RESCUE
PO BOX 246
Pittsford NY 14534

This form is designed to provide Rudy’s Rescue with adequate information on the dog that you are releasing.

It will be used to provide information to potential families considering this dog, to ensure that proper care of this dog is continued, and to protect both Rescue and the party releasing the dog.

General

Name of dog	Breed	Color
Breeder	Age	Weight
Is the dog purebred? Yes No
Is the dog spayed or neutered? Yes No
Do you have AKC registration papers on this dog? Yes No
If you have AKC registration papers, will you provide them, signed, transferring ownership of the dog? Yes No
Is the dog tattooed? Yes No If yes:
Tattoo Number	Registry	Phone
Is the dog microchipped? Yes No If yes:
Microchip registry	Phone
Does the dog have any scars or distinguishing features? Yes No
If yes, list:

Food

Type or brand(s) of dog food given:

How often is the dog fed each day? Once Twice

Medical

Name of veterinarian	Veterinarian Phone # Invalid phone number.Invalid phone number.
Veterinarian Address
You must contact your vet - please notify your vet that you are turning your dog over to Rudy's Rescue. A print out of the dogs medical records must be provided when you turn your dog over.
Is the dog on any heartworm preventative? Yes No
Last dose of heartworm prevention given on:
Last Heartworm test	Rabies due on:	Distemper due on:
Has the dog ever sustained major injuries? Yes No If yes, list:
Has the dog ever suffered any serious diseases? Yes No If yes, list:
Does the dog currently have any condition that requires medical treatment or special care? Yes No If yes, please describe:
Are you able to provide a complete medical TEMPERAMENT/TRAINING? Yes No

Other Information

Is the dog housebroken? Yes No Don't know
Is the dog good with children? Yes No Don't know
Is the dog good with other dogs? Yes No Don't know
Is the dog good with cats? Yes No Don't know
Has the dog had basic obedience training? Yes No Don't know
Is the dog crate trained? Yes No Don't know
Where is the dog kept during the day:
Where is the dog kept during the night:
Please list any characteristics a new owner may want to know about the dog.
Please explain why you are giving the dog up.

RELEASE OF OWNERSHIP AGREEMENT

I agree and understand that I am giving up all rights of possession and ownership of the described dog and that I will not be able to redeem this dog at any time nor will I be allowed to know the dog's whereabouts. I agree and understand that this dog is now the "sole property" of Rudy’s Rescue.

TO BE COMPLETED BY THE RELINQUISHING OWNERS: I(We) certify that we own the above dog and that this dog has not shown any signs of aggression, or bitten anyone and that the statements above are true and accurate. I(We) agree to indemnify and hold harmless Rudy's Rescue by, from and against all claims, suits, damages, liabilities, and costs related to or in any manner connected with this dog. We further acknowledge understanding that the dog becomes the Property of Rudy's Rescue, and that they may place the dog, spay/neuter, or euthanize it as they see fit. Additionally, I understand that Rudy's Rescue will not be able to communicate with me about any possible adoptive homes or the whereabouts of this dog.

Please Note: If you want to surrender a dog you must submit the owner surrender fee of no less than $100 plus the owner release form. Returned checks are subject to an additional $25 fee. Filling out this form does not guarantee that Rudy's Rescue will accept your dog into its program. If Rudy's Rescue does not accept your dog into its program, your Owner Surrender Fee will be refunded. Your Owner Surrender fee will be considered a donation and will not be refunded if Rudy's Rescue accepts your dog into its program and you re-home the dog on your own or change your mind and decide to keep your dog.

After completing our owner surrender form - you must print your complete information, sign it and mail it to our PO Box along with complete medical records from the veterinary hospital. If we do not have all requested information along with the fee your dog cannot be taken into our program.

Please advise your veterinary hospital that you are turning your dog over to Rudy's Rescue. This will make the records available to our medical staff.

You must check the box indicating your understanding of and agreement with the RELEASE OF OWNERSHIP AGREEMENT.
By checking this box, I signify that I have read, understand, and agree to the RELEASE OF OWNERSHIP AGREEMENT.

Your Name

Your Address

Your Phone
Your phone number is required.

Your Email Address
Your email address is required.

Amount you are donating to Rudy's Rescue to aid with reimbursement of veterinary
and other expenses incurred by this dog and others (if any).

A minimum donation of $100 is required with each owner surrender. Because we are a volunteer organization funded entirely by donations, we are delighted to accept any amounts over this minimum amount to help with the dogs in our care.

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Please let me know if you have any questions.

Amy

You must contact your vet - please notify your vet that you are turning your dog over to Rudy's Rescue. A print out of the dogs medical records must be provided when you turn your dog over.