TIP OF TEX K-9 RESCUE

OWNER SURRENDER/FINDER RELEASE

Name: ญญญญญญญญญญญญญญญญญญญ

Address:

City: State: ALABAMA --- AL ALASKA --- AK ARIZONA --- AZ ARKANSAS --- AR CALIFORNIA --- CA COLORADO --- CO CONNECTICUT --- CT DELAWARE --- DE DISTRICT OF COLUMBIA --- DC FLORIDA --- FL GEORGIA --- GA HAWAII --- HI IDAHO --- ID ILLINOIS --- IL INDIANA --- IN IOWA --- IA KANSAS --- KS KENTUCKY --- KY LOUISIANA --- LA MAINE --- ME MARYLAND --- MD MASSACHUSETTS --- MA MICHIGAN --- MI MINNESOTA --- MN MISSISSIPPI --- MS MISSOURI --- MO MONTANA --- MT NEBRASKA --- NE NEVADA --- NV NEW HAMPSHIRE --- NH NEW JERSEY --- NJ NEW MEXICO --- NM NEW YORK --- NY NORTH CAROLINA --- NC NORTH DAKOTA --- ND OHIO --- OH OKLAHOMA --- OK OREGON --- OR PENNSYLVANIA --- PA PUERTO RICO --- PR RHODE ISLAND --- RI SOUTH CAROLINA --- SC SOUTH DAKOTA --- SD TENNESSEE --- TN TEXAS --- TX UTAH --- UT VIRGIN ISLANDS --- VI VIRGINIA --- VA VERMONT --- VT WASHINGTON --- WA WEST VIRGINIA --- WV WISCONSIN --- WI WYOMING -- WY

ZIP:

Phone #:

Dog’s Name:

Age:   Sex:

Altered   Yes     No   

Date of Surgery:

Color:     Markings:

Coat type:

I, do hereby surrender the above named and described dog to the Tip of Tex K-9 Rescue on.

I release any and all claim to said animal and understand that I may not have the dog back nor inquire into the disposition of same. 

I also authorize the release of any medical records pertaining to said animal for the purpose of helping to place the animal.

I also acknowledge that the dog has not bitten anyone in the last 10 days to the best of my knowledge.

Signed:      Date:

Please check all boxes below.  If any of the boxes are left unchecked, your application will NOT be processed.

By checking this box I certify that the information provided on this form is true & correct. I understand that proper food and veterinarian care can be costly and I am financially and physically able to care for this animal.

By checking this box, I am indicating that this is a valid and legal substitution for my written signature on this legal document titled "Tip of Tex K-9 Rescue Foster care Application".

I have read Tip of Tex K-9 Rescue policies and agree to act in accordance with these policies and regulations.

____________________________________________________________

For office use

Date accepted into rescue: _____________      

Other identifying marks:  _________________________________________________

Veterinarian: _______________________ DVM.

Address: ___________________________ City: ___________________

State_____________________ Zip Code: _____________

Phone #: ______________________ Fax #: _______________________

Date medical records confirmed: _______________________

Medical Information: 

DHLPP due:  _____________

Rabies due: __________________

Bordetella due: ______________________

Other: ____________________________________________________________________

Please print & mail documents to:
Tip of Tex K-9 Rescue

C/O Dee Labunski

1514 S. 77 Sunshine Strip #24

Harlingen, Texas  78550  

Or Email to:

Labunski@aol.com

www.TipofTexK9Rescue.Org