Rescue to Rescue

The following animal(s) are being transferred from:

The following animal(s) are being transferred to: (Receiving rescue)

As of this date, rescue/organization transferring said animal(s) also transfers all ownership and responsibility of care to the receiving rescue. The receiving rescue/organization accepts all care and responsibility for said animal(s).

Animal(s) Name:

Animal(s) Species:

Animal(s) Breed:

Animal(s) DOB:

Animal(s) Coloring:

Animals Sex

Male
Female

Altered

Yes
No

Reason animal is being transferred:

Any known behavior issues:

Has the dog bitten a human, or other animal in last 10 days, if so explain

Has this animal recieved any veterinary care

Yes
No

If yes, Please explain

Is this animal UTD on vaccines

Yes
No

Transferring Rescue Organization Information

Organization Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Representative Name:

First

Last

Date / Time

Date

Time

Receiving Rescue Organization Information

Organization Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Representative Name

First

Last

Date / Time

Date

Time

Agreement and Signature

By filling in my signature, today's date and clicking the submit button:
1.I certify that all statements made by me on this document are true and correct.
2. I agree with this document in its entirety.

Signature

Clear Signature

Date / Time

Date

Time

Transferring Rescue Organization Information

Receiving Rescue Organization Information

Agreement and Signature

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