SHIBA INU RESCUE RELEASE FORM
(from old owner to Shiba Rescue)
I, owner of the below described dog, do release my ownership rights to:
________________________________________, who is a representative of Shiba Rescue.
Name:_______________________________________
Address:______________________________________
__________________________________________________
Date:__________________
Description of Shiba: Color: __________________Registration #:_________________
Tattoo #__________________________ microchip
#_________________________________
Other identifying characteristics:
Name:____________________
Sex:__________________ Neutered? ________Spayed?_________
Age:__________________
Name and address of
breeder:___________________________________________________
____________________________________________________________________________
Diet dog has been
receiving:_____________________________________________________
Housebroken?_______________, Good with cats?________________,
Noisy?______________
Jumper?_____________________ Good with
children?_______________________________
Good with other dogs?__________________________
Health history?______________________________________________________________
Date of last rabies immunization?____________, heartworm test:____________,
DHLPP:_______
Name and telephone number of Veterinarian who has cared for this
dog?________________________________________________________________________
Reason for release to Shiba
Rescue?_______________________________________________
_____________________________________________________________________________
Other comments:
I, a representative of Shiba Rescue, Hereby do take ownership and responsibility for this above
named and described Shiba Inu.
Name:___________________________
Date:____________________________
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