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Mosh Pit Rescue, Ownership Transfer Form

A Grand Rapids, Michigan 501c3 Dog/Cat Rescue serving West Michigan.

OWNER SURRENDER - By signing this form, I completely transfer ownership of my dog/cat to Mosh Pit Rescue.  Mosh Pit will make every effort to place this dog/cat into an appropriate home.  We understand this can be a difficult and emotional decision and we will do our very best to ensure care for this animal.    

Please complete the following to the best of your ability:

CURRENT OWNER / CURRENT VET:

CURRENT OWNER NAME:

ADDRESS:

PHONE NUMBER / EMAIL:

CURRENT VET: 

ANIMAL INFORMATION: 

DOG/CAT NAME:

DOG/CAT BREED:

AGE:

SEX:

SPAYED/NEUTERED (if so where was the animal spayed and approximately what date):

Has the animal been heartworm tested? 

Is the animal on HW preventative / flea treatment?

Is the animal current on Rabies?

Is the animal current on any other vaccines (DHPP, Bordatella, Lepto, FVCRP)? 

Is the animal microchipped?  (If so, Mosh Pit Rescue will transfer the microchip over to the rescue)

 

BEHAVIOR:

Has the animal been around other dogs??

Has the animal been around other cats??

Has the animal been around kids??

Does the animal have any behavior issues Mosh Pit Rescue should be aware of? 

Has the animal ever bitten anyone or any other animal? 

Are there any other behavior issues we should be aware of?  Please be honest. 

Why are you surrendering this animal? 

OTHER:

What is the animal currently eating?

Where does the animal currently sleep?

Has the animal ever been kenneled?

Where did the animal come from (a rescue, a shelter, purchased)?

How long is the pet left alone on a typical day? 

Is the animal potty trained / litter box trained / house broken?

If the current owner would like, Mosh Pit can try and provide updates on the animal.  This is not always possible, but we will try if the current owner would like that based on the circumstances.  By signing this form, the current owner acknowledges that Mosh Pit Rescue is under no obligation to provide any future information regarding this animal and all interest in the animal has been transferred. 

I hereby expressively waive and hold harmless Mosh Pit Rescue, their agents, owners, volunteers, and all other affiliates from any form of loss or claim of any nature, however caused, arising out of possession, ownership or presence of the animal.  Answers above have been truthful to the best of my knowledge. 

Mosh Pit Rescue agrees to do what is in the best interest of the animal, to provide medical care, and make every effort to find a proper home. Mosh Pit was founded by Julie Steffen and no animal may be owner surrendered to MPR without her approval.  MPR takes no financial responsibility for any animal surrendered to the rescue without her approval. 

 

SIGNATURE OF CURRENT OWNER:  __________________________________________

PRINTED NAME OF CURRENT OWNER:  _______________________________________

Mosh Pit Rescue Volunteer:  ______________________________________

Julie Steffen, Founder, Mosh Pit Rescue:  _______________________________

*no ownership transfer form is valid without signature from Julie Steffen. No person may authorize a transfer of ownership to MPR without her approval.