EMERGENCY Intake ONLY!

MUST be full breed dachshund

Surrender a Dachshund to LowRider.

We are currently accepting EMERGENCY surrenders only. All surrenders must be

Spayed/Neutered

Current on ALL vaccinations DHPP, Rabies, Bordetella (kennel cough)

Negative heart worm test.

A picture must also be submitted to verify breed. You can submit a surrender application here.

Surrender fee’s up to $100 may apply, this is to cover the continued care for the animal.

We are a independent, non-profit group, not funded by the state or any offices. We are under no obligation to accept an animal into rescue, this is a curtsy that we offer IF we have room.

Name

Pet Name

First Name

Last Name

Age

Breed

Coat, Color & Any Distinguishing Features

Health/History

Vet records available?

Vet's name

Put N/A if you don't have one.

Spayed or neutered?

Date of most recent shots (including rabies)

YYYY

Dog on heartworm preventative?

Please list any medical problems (allergies, etc.)

Other Information

Housebroken?

Crate-trained?

Uses a dog-door?

Has the dog ever bitten anyone?

If yes, please explain the circumstances

Reason for surrendering dog

Used to other dogs?

Used to children?

If Yes, Ages?

Any bad habits or behavior problems:

Any information that you could give us to better help us place this dog

Terms

I state that I am the sole owner of the above described dog and that no other parties have a legal interest in this dog. I relinquish all rights, interest, and ownership of above dog to LowRider Dachshund Rescue (LDR) and hereby relinquish all claims to said dog. I understand that this surrender is irrevocable and ownership of the dog is now relinquished to LDR. I certify that to the best of my knowledge that above dog is not aggressive and there are no bite claims filed against him/her. I agree not to hold LDR and/or any persons directly or indirectly involved with the surrender and future adoption of this dog harmless and indemnify the preceding against any and all claims, actions, demands, or liability of any kind whatsoever arising as a result or in connection with the above described dog. I further understand and agree that I receive no money or other compensation as a result of this surrender. The donation made to LowRider Rescue furthermore does not constitute a sale and that this donation will be used to benefit future dogs.

I agree to the terms listed above.

Yes, I agree

This release is made on this day:

YYYY

Name of Owner(s)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

E-Signature(s)

Witness

Surrender a Dachshund to LowRider.

LowRider Dachshund Rescue

About