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:   

 
 Earn 10% for Our Group -- Shop at The Inky Paw!
Where Your Purchase Helps Support Rescue!
Order a new collar and leash, an "Udder tug", or a "rescue ribbon" for your car - and 10-50% of your purchase will go to Mid-Florida Retriever Rescue, Inc.


IMPORTANT: You must indicate that your purchase is for the benefit of
Mid-Florida Retriever Rescue, Inc.
in the message section of the check out process.

 
 
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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
 
 
Last Update
June 17, 2008
 
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