Pekingese Rescue Network Inc., Owner’s Release Agreement
Please print, fill-out, sign, and provide to PRNI with the dog. Thank you.
Date:
Breed:
Sex: MALE FEMALE Altered: YES NO
AKC#: Color:
Dog’s Registered Name:
Call Name: Age:
Owner’s Name: Phone:
Owner’s Address:
City / State: Zip:
Housetrained: YES NO Crate Trained: YES NO
Leash Trained: YES NO Barker: YES NO
Digs: YES NO Dog Aggressive: YES NO
Jumps Fence: YES NO Obedience Trained: YES NO
Shot Record:
Wormed:
Type Of Dog Food Fed:
Amount per Feeding: Feeding Per Day: AM PM BOTH
Veterinarian Name and Phone #:
Dog Does…
Sleeps In House Sleep On Bed Or Furniture
Does Tricks Housebroken
Gets Along With Cats Gets Along With Other Animals
Chews Ride Well In Car
Other Behavior…
Behavior With Children:
Has Your Dog Ever Attacked Another Animal: YES NO Explain:
Attempted To Attack: YES NO
Has Your Dog Ever Bitten A Person: YES NO Explain:
Attempted To Bite: YES NO Explain:
Owner Release Page 1 of 2
It is understood that rescue does not buy or pay for dogs. This is a service to help place
dogs in new homes when their present owners can no longer keep them. This service is
free, however a donation to help pay for expenses is appreciated. Please Read, Sign And
Date The Following:
I, ______the owner, herby make available for
adoption, the dog named ______, to Pekingese Rescue Network
Inc, the rescue agency. I certify that I am the owner of this dog, free and clear of all other
interests. I certify that this dog is not possessed of any dangerous or vicious propensities,
and that I have not willfully concealed information about the dog that might indicate such
propensities. The information I have provided about this dog is true and complete. I
herby forever release, discharge and agree to hold harmless and indemnify the rescue
agency, its board of directors, its members, officers, and agents from all claim, demands,
actions, causes of action, or liability of any kind whatsoever arising as a result of or in
connection with the adoption or other disposition of the above named dog.
I also agree my name and phone number may be released to the new owner of this dog
and that the new owner may contact me if he wishes to gain any further information on
this dog.
Signed By Owner:
Date:
Signed by Rescue
Date
Owner Release Page 2 of 2