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Owner Relinquish Form

Owners First Name *

Owners Last Name *

Street Address *

City, State and Zip *

Phone Number *

Email Address *

Vet name and Phone number * 🛈

Dogs Name *

Dogs Breed *

Dogs Age or Date of Birth *

This dog has lived *

Indoors

Outdoors

Please upload vet records

If available, please upload a picture of the dog

Is this dog housetrained? *

Is this dog crate trained or leash trained? *

This dog is *

Spayed

Neutered

Not altered

How long have you had this dog? *

Where was this dog acquired? *

Please explain the circumstances that require you to rehome your dog. *

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

This dog has lived with *

Cats

Kids

Other dogs

none of the above

Date of last Rabies Vaccination * 🛈

Date of last Heartworm test *

Date of last Distemper Vaccination *

Date of last kennel cough vaccination ( if applicable)

When do you need to surrender your dog by? * 🛈 +

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Wooftown Rescue Inc
130 Buell Rd
Rochester NY 14624
Phone: (585)298-3001
Fax: (585) 423-0771
rescue@wooftowndoggydaycare.com