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1158 26 T H Street, Santa Monica, CA 90403 310.74-LHASA • 310.745.1551 Fax RELEASE OF
1158 26 T H Street, Santa Monica, CA 90403 310.74-LHASA • 310.745.1551 Fax RELEASE OF

1158 26 TH Street, Santa Monica, CA

90403

310.74-LHASA 310.745.1551 Fax

RELEASE OF ALL CLAIMS

I hereby release to LHASA HAPPY HOMES RESCUE, this pet as described herein:

Dog’s name

Belle

Age

5

Birthdate (if known)

June

6

Male



Female

Weight

19

Color

White

Breed

Lhasa

Apso



Spay/Neutered

2003

(date)

Reason(s) you are giving up:

Do

not have the funds or time to car for her

DOG INFO:  Housebroken  OK/dogs  OK/Cats  Good w/ kids  Gives Kisses
DOG INFO:
Housebroken
OK/dogs
OK/Cats
Good w/ kids
Gives Kisses
Protective*
Snappy*
Food Aggressive
Separation Anxiety Destructive/chews*
Plays w/ toys
Barker*
Uses Doggie Door
Ok Alone during Day
Knows Commands*
Good in the car
Good on Leash

*Please explain –Protective and barker-Lhasa’s were bred to be alarm/guard dogs by barking at strangers ergo she barks Commands she knows how to sit, stay, come, kiss,

Ever bitten anyone/drawn blood/stitches? Explain (please provide dates and circumstances)

Dog came from Friend

them know dog needs to be rehomed? Yes *Name of Pet Store purchased from



Breeder Rescue Pet Store*

Store purchased from  Breeder  Rescue  Pet Store*  No *Have you contacted original

No

*Have you contacted original breeder or rescue to let

If not, why not? In Georiga Phone #

Flea Control:  Yes  Shots Up to Date?
Flea Control:
Yes
Shots Up to Date?
No Type:  Date Last rabies
No
Type:
Date Last rabies

Frontline

10/08

Advantage Revolution

DHLPP

10/08

Last Given (date)_12/08

Bordatella

10/08

Any special needs? Phenobarbital

Has the dog received obedience training? Yes No Explain: Brand of food? Pedigree Wet 
Has the dog received obedience training?
Yes
No
Explain:
Brand of food? Pedigree
Wet
Dry Feeding Time(s)/Amt Any
Presently sleeps in
Own Bed
Human Bed
Outside Other:
Is he/she microchipped?
Yes
No
 Avid
Home Again  Other
#

Any medical issues/on any medication: (Allergies, health history, etc) Phenobarbital b/d of epilepsy

Best/Worst characteristics of your dog (including any “attitude”): Extremely loving and great happy demeanor, needs lots of love!

1158 26 T H Street, Santa Monica, CA 90403 310.74-LHASA • 310.745.1551 Fax ANYTHING YOU
1158 26 T H Street, Santa Monica, CA 90403 310.74-LHASA • 310.745.1551 Fax ANYTHING YOU

1158 26 TH Street, Santa Monica, CA

90403

310.74-LHASA 310.745.1551 Fax

ANYTHING YOU CAN TELL US ABOUT YOUR DOG THAT WILL HELP US IN REHOMING:

She is perfect we cannot care for her b/c of 2 new babies and the time and money it takes to care for them

What will you be sending along with the dog (food, bed, toys, crate, etc)? Crate, toys

Donation to Lhasa Happy Homes for spay/neuter/placement/shots/fostering:

$

Upon my release of the above-mentioned pet, I agree to allow Lhasa Happy Homes Rescue (LHH) select a new home for this animal, which they deem to be appropriate, without any involvement from me (as the former pet owner), unless agreed upon in advance. By signing this document, I, being of lawful age, do hereby release, acquit and forever discharge LHH and their employees, agents (hereinafter collectively designated as the releasees) of and from any and all allocations, causes of action, claims, demands on account of or in any way growing out of any and all claims of any kind resulting, or to the result from, or by reason of the conduct of releasees occurring at either any time prior hereto or hereinafter.

Further, by signing this document below, Lhasa Happy Homes certifies that it will foster and care for your dog(s) until such time as they are re-homed with a permanent family. We will house and board, vet and medicate, spay/neuter if necessary, groom, de-worm

and provide a loving environment for your pet. research or anything related thereof.

We will not, under any circumstances, resell your animal for the purposes of medical

DOG’S NAME: BELLE

Agreed to and accepted by

Name – Please Print

Pet Owner (Releaser) Signature

Address

on

this

Date

Email Address:

Phone:

day

of

Month

, 2006.

City/State

Zip

VETERINARIAN:

 

(name)

(Clinic)

PHONE

IMPORTANT: Please attach copies of current shot records, sterility and rabies certificates and send along
IMPORTANT: Please attach copies of current shot records, sterility and rabies certificates and send along

IMPORTANT: Please attach copies of current shot records, sterility and rabies certificates and send along with a

records, sterility and rabies certificates and send along with a signed copy of this Owner Release

signed copy of this Owner Release Form (OTI). Thank you.

records, sterility and rabies certificates and send along with a signed copy of this Owner Release