Relinquish Agreement

"*" indicates required fields

Dog's Name*

Age*

Color*

Gender*

Male

Female

Spayed/Neutered?*

Yes

Not Sure

Date of Spay/Neuter

Veterinarian Name

Vet Phone

Heartworm Test Date

Heartworm Prevention

Date of last dose - Heartworm

Flea/Tick Prevention

Date of last dose - Flea/Tick

AKC Registered

Microchip #

List known medical or physical problems

Has the dog growled, bitten, or shown aggression towards any person or other animal?

Reason you are relinquishing your Labrador to Rescue*

Where did your dog originally come from?

I hereby give and relinquish one Labrador Retriever as specified above. I declare that I am the legal and sole owner and that there are no encumbrances to my title to him/her. He/she is being released and accepted with or without AKC registration and with no implied guarantees as to placement with Cincinnati Lab Rescue, Inc.

Enter your full name*

Email*

Phone*

Address*

Are you willing to foster until your dog is adopted?*

Yes

Signature*

Date

Name

This field is for validation purposes and should be left unchanged.

Relinquish Agreement

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