EmailMe Form - Rescued Hearts Northwest

Your Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email *

Would you like to opt in to our newsletter? (We will use your email ONLY for Rescued Hearts Northwest purposes: to let you know about RHN news, volunteer and foster opportunities, events, and of course adoptable pets.)

YES!

No thank you.

Home phone *

### - ### - ####

Cell phone

### - ### - ####

Work phone

### - ### - #### Ext. ###

I would like to: *

Relinquish ownership

Owner/foster

What is your time frame for finding this pet a new home? *

Pet Information

Type of pet *

Dog

Cat

Other

WHEN did you get this pet? *

WHERE did you get this pet? *

Why are you relinquishing this pet? Please be specific. *

Pet's Name

Pet's age or birth date if known. *

Breed if known or breed mix (best guess is okay). *

Describe color and distinctive markings.

Please attach a photo of your pet if possible.

Size *

Gender *

Male

Female

What kind of pet food do you feed this pet?

How often do you feed this pet?

Is your pet spayed or neutered? *

Yes

No

Is your pet up-to-date on vaccinations? *

Yes

No

Not sure

Where do you take this pet for veterinary care? *

Does this pet have any medical issues or health concerns? Please describe. *

Does this pet have a microchip? *

Yes

No

Is this pet housebroken? *

Yes

No

What is this pet's activity level?

If you are relinquishing a dog, is he/she leash trained? *

If you are relinquishing a dog, is he/she crate trained? *

Where does this pet sleep at night? *

Where does this pet spend the day? *

How long is this pet left alone when you are away? *

What is this pet's behavior around other dogs? *

What is this pet's behavior around cats or small animals other than dogs? *

What is this pet's behavior around around livestock? (Does he/she chase, nip, etc.). Please describe. *

What is this pet's behavior around children? *

Has this pet had any professional training or know any commands or hand signals?

Yes

No

Does this pet have any aggression issues? Please describe. *

Does this pet have a bite history with people or other pets? *

Yes

No

If Yes, please describe

Please describe anything appealing, cute, or special about this pet's personality.

By entering my name and date below, (I/we) fully understand that by executing this document and delivering the above-described animal to Rescued Hearts Northwest that (I/we) hereby relinquish any and all legal and equitable rights of ownership of the above-described animal.

(I/we) represent that (I/we) are the lawful owner(s) of, and have good title to and the right and power to gift, sell, assign, transfer, convey and deliver said animal; and that said animal is free and clear from claims of ownership or other encumbrances of any kind or nature whatsoever by any other person or entity.

(I/we) understand that Rescued Hearts Northwest will act in the best interest of said animal in its care and placement. By assuming ownership, Rescued Hearts Northwest reserves all rights in making all decisions in regard to the animal’s care, placement and medical treatment.

(I/we) understand that Rescued Hearts Northwest has the right to return said animal to owner if animal shows aggression in the Foster Home.

I have answered all questions to the best of my knowledge and agree to all terms and conditions above.

Enter full name. *

Today's Date *

MM / DD / YYYY