CSRMP Owner Info and Release Form

Date:
Breed:Cocker Spaniel
Sex: MALE [ ] FEMALE[ ]
Altered: YES[ ] NO[ ]
AKC#:
Color:
Dog's Registered Name:
Call Name:
Age:
Owner's Name:
Phone:
Owners 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:

Amount per Feeding:
Feeding Per Day: AM[ ] PM[ ] Both[ ] Free feed[ ]
Breeder:

Veterinarian:

Does dog...
Sleeps In House?
Sleep On Bed Or Furniture?
Does Tricks?

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 [ ]
Attempted To Attack: YES[ ] NO[ ]
Has Your Dog Ever Bitten A Person: YES[ ] NO[ ]
Attempted To Bite: YES [ ] NO[ ]

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, hereby make available for adoption,
the dog named ________________________,
to ____________________, the CSRMP/WiggleButtExpress Cocker Rescue.
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 hereby forever release, discharge and agree to hold harmless
and indemnify CSRMP/ WiggleButtExpress Cocker Rescue, its board of directors,
its members, officers, and agents from all claims,
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:

© 1997 wigglebuttexpress@iname.com

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