First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Cell Phone*
Rescue/Shelter Name*
Date of Intake*
Reason for intake of dog*
Dog Name:*
Was the dog wearing a collar?
Was the dog scanned for a microchip?
Did you make an effort to find the owners of the dog?
Have you noticed any injuries, aggression, odd behaviors, or other problems we should know about before placing the dog in a foster home?
If yes, please explain
To the best of my knowledge, the Boston Terrier mentioned above has not bitten a human or shown aggressive tendencies toward humans. I understand the rescue requires all unaltered dogs to be neutered or spayed prior to adoption. I hereby release all control and claim to this dog and declare that the above information is true and correct to the best of my knowledge. I understand this is a permanent decision on my part and that I am not entitled to receive reports on this dog or be given any information on its adoptive family or the dog's whereabouts. By my electronic signature, I fully understand that I relinquish all rights to the above mentioned dog and that I will hold Arizona Boston Terrier Rescue and its officers harmless. Type your name as your electronic signature*
Retype your name as your electronic signature*
Please enter today's date*
