DOUGLAS COUNTY CANINE RESCUE
ANIMAL RELENQUISHMENT FORM
I ____________________________ agree to relinquish full custody and ownership of my dog to
Douglas County Canine Rescue, for placement into the foster and adoption program. I
understand by signing this form I no longer have decision making rights or custody rights, and
the rescue will make decisions about my dog’s care at their discretion.
Name____________________________________
Address________________________________
State_________
Zip Code_________
Date__________________
City________________________
Phone_____________________________
Please answer all questions truthfully and to the best of your knowledge. Potentially negative
information does not necessarily deem your dog unadoptable. We need complete information to
be able to match your dog to potential adopters.
Dog’s Name_____________________________ Age______Breed___________________
Color____________________ Sex: M F Spayed/Neutered: Y N When__________________
What age did you acquire your animal?_________ Where?_____________________________
Has this animal been to a Veterinarian?______________ Clinic Name_____________________
Please explain in detail why you are relinquishing your animal
______________________________________________________________________________
______________________________________________________________________________
Describe your dog’s personality____________________________________________________
______________________________________________________________________________
Has your dog had issues with cats, kids, other dogs or livestock? If yes, please
explain________________________________________________________________________
______________________________________________________________________________
DCCR’s policy is that we do NOT accept dogs that have a history of dangerous propensity (i.e.
the dog has bitten someone in the past, that is, it had its “first bite” already. The dog regularly
snaps at people or has to wear a muzzle “just to be safe” or you warn people that the dog bites.)
I certify that I am the Current Owner* of the above named dog and that I have the authority to
relinquish ownership of this dog to Douglas County Canine Rescue. I understand that DCCR
will make all future decisions regarding the above named dog and I authorize them to make
decisions about the welfare of the dog without my consent or knowledge. I hereby relinquish
my ownership and control of this dog to DCCR.
Signnature:______________________________Print:__________________________
Date:____________________
* If I acquired this animal as a stray, I certify that I have followed Colorado State Law by
notifying Animal Control in the area where the dog was found not more than 24 hours after I
found the dog. I further certify that I have done everything possible to try to reunite the dog
with its rightful owners by: (Initial all that apply):
___ Placing an ad in the local newspaper in the area the animal was found.
___ Posting "Found" notices at the following places: location the animal was found; local feed
stores or pet supply stores in the area the animal was found; local veterinarians in the area the
animal was found; local grocery and/or convenience stores in the area the animal was found.
___ Other:
________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Date that the dog was found:______________________