Dog Release Form

Date*
MM slash DD slash YYYY
Owner's Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Is this a walk-in?
- Yes
- No
Provide proof of ownership
- Vet Records
- Microchip
- Documentation of years owned
- Stray (none)
Name of Animal*
Breed (if known)
Age of Animal (if known)
Vet Info
Please provide your veterinarian's name and phone number (Pet Haven will require records prior to placement).
Consent*
I hereby transfer ownership of my animal to Pet Haven Inc of MN. This animal is being released to Pet Haven for the purpose of finding it a new home. Pet Haven retains sole responsibility for the selection of a new owner and to provide the veterinary care it deems appropriate during the time the animal is in care of Pet Haven. I have received no other representations or assurances from Pet Haven as an inducement to transfer ownership. I understand that by signing this agreement I forfeit all property rights and claims to the animal and authorize the release of veterinary records relating to this animal to Pet Haven. I attest that this animal has not bitten anyone during the past 10 days and is not under quarantine.
Check this box if you agree to the terms noted above.
Pet Haven Representative*
Date*
MM slash DD slash YYYY