Mid-Florida Retriever Rescue, Inc.
Pet Surrender/Release Form
if you have a retriever you wish to place in our care for adoption.

Use this easy form to complete your surrender application or if you prefer you can download this form here in Adobe Acrobat, print it and after completion mail or FAX to:

Mid-Florida Retriever Rescue, Inc.
15195 Angus Road
Polk City, FL 33868
FAX:  863-984-5370

Name
Address
City & State
ZIP or Postal Code
Phone
E-mail Address

Reason for surrender:  

Enter this code in the space below:   53ps37   This is your digital signature.

Signed 

Date
                                                                                                   

 
Any Additional information that is applicable:

Pets color and markings:

 

Age and Weight:  

Gender:                                         

AKC ID:

Type of food and frequency:  

Pets likes or dislikes: other dogs, cats, birds, etc.:

Pet: chews, digs, barks, comes when called, jumps on people:  

Is the pet crate trained?  

Does the pet stay in the house for a period of time alone unattended:                                        

Does the pet know any commands or tricks?  

Pets Veterinarian and phone number:  

Last at the vet:  

Any special medical needs?  

On heartworm prevention?  

Date last given:                                                                                                   

Surrender Fee:  $100.00   

Surrender Fee paid via:   

 
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Mid-Florida Retriever Rescue, Inc.
15195 Angus Road
Polk City, FL 33868
FAX:  863-984-5370


Email:
info@mid-floridaretrieverrescue.org
 
Business Hours:

by appointment only
 
Last Update
January 08, 2014
Content Copyright 2014
All Rights Reserved.
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Mid-Florida Retriever Rescue, Inc. is a not for profit corporation, in the state of Florida, with a
501 (c) 3, IRS designation.
Federal ID Number: 20-1823790 | FL. Registration #: CH22130
A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.
Mid-Florida Retriever Rescue does not use professional solicitors and 100% of donations are received by the organization to provide for the care and development of our rescues.

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