Owner Relinquish Form
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Owners First Name
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Owners Last Name
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Street Address
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City, State and Zip
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Phone Number
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Email Address
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Vet name and Phone number
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Dogs Name
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Dogs Breed
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Dogs Age or Date of Birth
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This dog has lived
Indoors
Outdoors
If available, please upload a picture of the dog
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Is this dog housetrained?
Yes
No
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Is this dog crate trained or leash trained?
Crate trained
Leash trained
Both
Neither
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This dog is
Spayed
Neutered
Not altered
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How long have you had this dog?
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Where was this dog acquired?
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Check all the apply:
This dog has been aggressive with other dogs
This dog has been aggressive with Cats
This dog has been aggressive with Children
This dog has not shown any aggression
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This dog has lived with
Cats
Kids
Other dogs
none of the above
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Date of last Rabies Vaccination
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Date of last Heartworm test
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Date of last Distemper Vaccination
Date of last kennel cough vaccination ( if applicable)
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Indicates Response Required
Wooftown Rescue Inc
130 Buell Rd
Rochester NY 14624
Phone: (585)298-3001
Fax: (585) 423-0771
rescue@wooftowndoggydaycare.com