RELINQUISHMENT INFORMATION FORM Submitting this form does not constitute an agreement of relinquishment from Jack Russell Terrier Rescue Ontario. It is merely the initial step in the relinquishment process and will help us decide if your dog is acceptable for release. A representative from the rescue will contact you if you have supplied sufficent contact information. All Dogs must be free from contagious diseases. Reports of any biting will be taken into consideration. All information must be reliable and a reference is required. All rescues will be spayed or neutered within 7 days of being adopted, if not already. Owner Information - For Office Use Only Name: Home Phone: Address: City: Postal Code: Email: How long have you owned the terrier? Were there previous owners? Yes No Permission to give your phone number to approved applicants? Yes No Best time to call? Reference Name Reference Phone How did you hear of the rescue? Web Search Word of Mouth PetFinder Other Website (please specify) JRTCA Magazine (please specify) JRTCC Dog Event (please specify) Other (please specify) Dog Information Name: Sex: Age: Color: Spayed/Neutered: Yes No Coat Type: Weight: Why is this dog up for adoption? Allergies? to what? On Medication? Shots up to date? Yes No Next shots due? Able to verify shots are to date? Yes No Any physical problems? what? Housebroken? Yes No Crate trained? Yes No Leash trained? Yes No Rides well in car? Yes No Current Brand of Food Daily Food Intake Likes? Dislikes? How does dog spend day? Indoor Outdoor Crated Tied Loose Yard Kennel Run Any other pertinent information? Breeder Information Bought from: Breeder Pet Store Shelter If breeder, have you notified? Yes No Name: What was the breeder's reaction? How Does the Dog React to... Other dogs Children Cats Strangers Being alone in home Being alone in yard Going for walk Dog Traits/Training Chewing Digging Excessive Barking (reason) Snapping/Nipping (reason) Aggressiveness(to what) Shy(to what) Ever bitten anyone? Why? Obedience Classes Does tricks?
Jack Russell Terrier Rescue Ontario (JRTRO) Copyright 2003-2004. All Rights Reserved.
Last Updated: September 21, 2004