Carolina Basset Hound Rescue, Inc.

Owner Relinquishment Form

Please complete this form to generate the agreement for you to sign.
Owner
Name:
Address:
City:
State:
Zip:
Email:
Telephone:
Basset
Did you adopt this dog from CBHR and now want to return it?
Name:
CBHR Tag:
Microchipped?
If so, number:
Age:
Color:
Sex:
Male
Female
Do you agree to sign the Relinquishment Form electronically?

Yes

No

Your help completing the following will be appreciated. Please answer as much as you can.
Origin of dog:
Vet clinic used:
Health record:
Dates of innoculations and tests
Rabies:
Tag number:
DHLPP:
Heartworm test:
Results:
Fecal test:
Treatment, if any:
Heartworm preventative used
Medication:
Next due date:
Flea control used
Medication:
Next due date:
Date of spay/neuter if known:
Current medications:
Feeding schedule:
Brand, type, amount, times
Preferences:
House trained?
Any bad habits?

When you submit this form, you will be taken to the form to initial and sign. This relinquishment form is not complete until you enter your signature and initials on the second page.

Carolina Basset Hound Rescue, Inc., PO Box 80082, Charleston, SC 29416