Owner or Finder Relinquish Statement
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I,
, am voluntarily releasing all rights of ownership to San Francisco Samoyed Rescue
for the Samoyed known as
as of
(date)
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Samoyed Rescue reserves the right to refuse adoption to anyone. All medical, spay/neuter, foster care, and adoptions are left to the discretion of Samoyed Rescue and it's representatives. No animal is accepted into Samoyed Rescue for any reason other than placement as a pet. This animal may be euthanized at the discretion of Samoyed Rescue if medical or behavioral problems prohibit its placement.
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To my knowledge, this dog has NOT bitten anyone in the last ten (10) days.
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I hereby Authorize this electronic signature submittal to serve as my legal signature.
Signature (enter owner's/finder's full name):
Today's Date:
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Current Owner/Finder Full Name:
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Drivers License Number and State:
Home Phone:
Cell Phone:
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Street Address:
City
State
Zip
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Information About Animal Relinquished
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Gender:
DOB/Age:
Weight:
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Distinguishing Marks or Features:
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Municipal License/Chip Number:
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Breeder Name/Location:
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If Found, Location and Date:
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Type & Brand of Food:
Amount of Food Per Day:
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Veterinarian Name & Phone:
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Date of Last Rabies Vaccination:
Expires:
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Reason(s) for Relinquishing Dog:
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SFSR Doggy Resume
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Dog's Name:
Dog's Age:
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Predominant Breed:
Secondary Breed:
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Dog's Gender:
Spayed or Neutered:
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Medical
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Current on Rabies Vaccination:
Current on DHLPP Vaccinations:
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Medications Currently Taking:
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Special Medical Needs (ex: allergies, skin problems, arthritis, special diet, etc.):
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