First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

This Agreement to transfer ownership ("Agreement") is entered into on this ________ day of ______________________, 20_____.

I am the owner of the below described dog, do hereby permanently and irrevocably transfer ownership of this dog to Bichons and Buddies. By executing this Agreement, I acknowledge that I am irreversibly relinquishing to Bichons and Buddies, any and all rights, title, and ownership that I had or may have had with respect to this dog.  I further acknowledge that I am the owner of the dog and am fully authorized to enter into this Agreement.

What is the breed of your dog?*

If your dog has a microchip, what is he/her microchip #?

Other identifying characteristics:

Is your pet spayed or neutered?*

Vet's Name

Address

Phone

What is the name and type (dry, canned, etc) of dog food do you feed your dog?*

How often do you feed your dog? What time?*

Is your dog housebroken? Uses weewee pads or dog door? If not housebroken, please explain.*

How often does your dog go for a walk?*

Does your dog go on car rides? How often?*

Please list characteristics/personality traits of your dog. (i.e. cuddler, independent, affectionate, needy, excitable, barky, etc.)*

Is your dog good with children? If not, please explain.*

Is your dog good with cats? If not, please explain your dog's reaction towards cats.*

Does your dog get along with other dogs? If not, please explain.*

Does your dog have any destructive or negative behavior? If yes, please explain.*

Please describe your dog's overall health. How often has your dog been to the vet and for what purpose?*

Date of last rabies immunization?*

Date of last heart worm test?*

Date of last DHLPP vacination?*

Date of last vet visit?*

Has your dog ever bit a person or another animal? If yes, please explain when, who were involved, how severe the bit wounds were, etc.*

What is the reason you want to release your ownership of your dog to Bichons and Buddies?*

Please include any other relevant information about your dog here, if any.*

Amount of donation you are giving Bichons and Buddies to care for your dog until adopted:

By signing this Agreement, I acknowledge that I have read the Agreement and that it is a binding legal contract. Signature (type your name)*

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I,____________________________________________, a representative of Bichons and Buddies hereby do accept responsibility for the above named and described dog on behalf of Bichons and Buddies.