Randi Berger's Recycled Pets Rescue

Randi Berger

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Give-Up Form

Breed (if mixed, please list all known breeds):
Age:
Dog's Name:
Gender:	Male Female
Weight (best guess):
Color:
Is your dog good with kids?	Yes No
...good with cats?	Yes No
...good with other dogs?	Yes No
...good with strangers?	Yes No
...housetrained?	Yes No
...spayed/neutered?	Yes No
...current on all vaccinations?	Yes No
...an indoor dog?	Yes No
Reason(s) for give-up, any health problems and/or special needs:
Date by when your dog needs to be placed:
When will you be available to bring your dog to us in the Encino/ Tarzana area?
Your Name:
Address:
Address 2:
City:
State:
ZIP:
Telephone (day):
Telephone (eve):
Email address:
Best time to reach you:
Terms and Conditions for submitting this application:	I declare under penalty of perjury under the laws of the State of California that I am the legal owner of the dog I am giving up or that the dog was lost or abandoned and I have made a good-faith, diligent but unsuccessful attempt to locate its owner. I understand that I may incur criminal and/or civil penalties if the foregoing is not true and correct.
	By clicking Submit Form button I declare under penalty of perjury that I have READ and AGREE to the ABOVE Terms and Conditions

Recycled Pets Rescue was established in 1987 and is an all-volunteer 501 (c) 3 non-profit charity. A portion of your contributions are tax-deductible.

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