Agreement to Transfer Ownership of Dog

This Agreement to Transfer Ownership of Dog ("Agreement") is entered into on this __________ day of___________, 200__. I, _______________________________, owner of the below described Dog, do hereby permanently and irrevocably transfer ownership of the dog to Small Paws® Rescue, Inc. By executing this Agreement, I acknowledge that I am irreversibly relinquishing to Small Paws® Rescue, Inc. any and all right, title, and ownership that I had or may have had with respect to the Dog. I further acknowledge that I am the owner of the Dog and that I am fully authorized to enter into this Agreement.

Description of Dog: Breed: __________________ Registration #: ________________ Tattoo #_________________ Microchip #: _________________ Other identifying characteristics: Name:____________________ Age: __________________ Color: __________________Sex:________________ Neutered? ________ Spayed? _________ Name and address of breeder if known: ______________________________________________ Diet Dog has been receiving: ______________________________________________________ Has Dog Ever Bitten Anyone? ______ If Yes Why? ____________________________________ Housebroken? _______________ Noisy? _____________________ Jumper? __________________ Destructive? __________________ Good with children? _____________________________________ Good with cats? ____________ Good with other dogs? __________ Health history? _________________________________________________________________ ________________________________________________________________ Date of last rabies immunization? ___________ Heart worm test: ____________ DHLPP: _______________ Name and telephone number of Veterinarian who has cared for this dog? _______________ ________________________________________ Reason for release of Dog to Small Paws® Rescue, Inc. _____________________________ _________________________________________________________________ ____________________________________________________________ Other comments: _______________________________________________________________ _________________________________________________________________ _________________________________________________________________ Amount of donation coming with Dog into rescue, to help defray costs for care, until adoption $____________.

By signing this Agreement, I acknowledge that I have read the Agreement and that it is a binding legal agreement. Printed Name: _______________________________________________________________ Printed Name: ______________________________________________________ Address:___________________________________________________________ Signature: _________________________________________________________________ Signature: _________________________________________________________ I, ________________________________, a representative of Small Paws® Rescue Inc., hereby do accept responsibility for the above named and described Dog on behalf of Small Paws® Rescue, Inc. _________________________________________________________________ Signature of Small Paws® Rescue Volunteer