Relinquishment Form




Please explain “no” answers below.


Problem Behaviors:

Please explain any “yes” answers below.

Please attach current vet records or provide the contract information of your current veterinarian:

By submitting this form, I acknowledge that:

  • I acknowledge that I am giving up ownership of "Dog" to the rescue specified.
  • I acknowledge that by signing this Relinquishment Form I have no further claim to Dog.
  • I acknowledge that Celtic Corgi Rescue/Oklahoma Jack Russell Rescue have not given any guarantee with regard to Dog.

Please consider making a monetary donation now to help us care for your dog during his or her
stay with us. This donation will go to cover food, shelter, medical and other expenses. We are
dedicated to finding the best possible home for your dog. To do this effectively, we rely on you to
provide us with accurate information

All of the information I have provided is true and complete to the best of my knowledge.