Relinquishment Form

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Information on how to Relinquish a Basset.

Relinquishment Form

Please fill out as many fields as possible.

***Pressing Enter on your keyboard while filling out this form will submit the form before you are finished. Use Tab or your Mouse to move to the next field***

NOTE: By filling out this form you are NOT signing ownership of your dog to ABCBHR, Inc. You will need to sign ownership over to ABCBHR, Inc. when a volunteer picks up the dog.

*Name*
*Street Address*
*Address (cont.)*
*City*
*State/Province*
*Zip/Postal Code*
*Home Phone*
*E-mail*

Name Of Dog: Color:

Age: Sex::

Please provide the following information about your veterinarian.

*Name*
*Organization*
*Street Address*
*Address (cont.)*
*City*
*State/Province*
*Zip/Postal Code*
*Phone*

Please explain the circumstances surrounding this relinquishment.

Is the dog neutered or spayed? YES NO

Does the dog up to date on shots? YES NO

Does the dog get along with other dogs? YES NO

Please Explain

Does the dog get along with cats? YES NO

Please Explain

Does the dog get along with young children (9 and younger)? YES NO

Does the dog get along with school age children (10 and over)? YES NO

Please Explain

Is the dog housebroken? YES NO

Please Explain

Has the dog bitten a person or other animal? YES NO

Please Explain

Has the dog displayed any aggressive behaviors such as food aggression or toy aggression? YES NO

Please Explain

Does the dog have any behavioral problems? YES NO

Please Explain

Does the dog have any medical problems? YES NO

Please Explain

How long have you owned the dog?

All of the information that is included in this form is to the best of my knowledge, true and complete. I understand that falsifying information on this form, or at any other time during the relinquishment process may disqualify my Basset from acceptance into ABCBHR, Inc.

I am aware that submitting this form does not guarantee that my Basset will be accepted into ABCBHR, Inc.

I also understand that by submitting this form, I give ABCBHR, Inc permission to access my veterinary records.