The following animals are being transferred from _________________ to ________________.
As of _____________ the rescue/organization transferring said animal(s) also transfers all
ownership and responsibility of care to the receiving rescue. The receiving rescue/organization
accepts all care and responsibility for said animal(s).
Animal 1
Name Breed/Species
Gender Altered? Yes No Color
Size when grown: Small Med Large Age:
Reason animal was
surrendered:
Reason animal is being
transferred:
Known medical/behavioral
issues:
Has this animal receive any veterinary care? Yes No If yes, what was the reason for medical
care?
Veterinary Clinic:
Current diet:
Notes:
Animal 2
Name Breed/Species
Gender Altered? Yes No Color
Size when grown: Small Med Large Age:
Reason animal was
surrendered:
Reason animal is being
transferred:
Known medical/behavioral
issues:
Has this animal receive any veterinary care? Yes No If yes, what was the reason for medical
care?
Veterinary Clinic:
Current diet:
Notes:
Animal 3
Name Breed/Species
Gender Altered? Yes No Color
Size when grown: Small Med Large Age:
Reason animal was
surrendered:
Reason animal is being
transferred:
Known medical/behavioral
issues:
Has this animal receive any veterinary care? Yes No If yes, what was the reason for medical
care?
Veterinary Clinic:
Current diet:
Notes:
Animal 4
Name Breed/Species Gender Altered? Yes No Color
Size when grown: Small Med Large Age:
Reason animal was
surrendered:
Reason animal is being
transferred:
Known medical/behavioral
issues:
Has this animal receive any veterinary care? Yes No If yes, what was the reason for medical
care?
Veterinary Clinic:
Current diet:
Notes:
Transferring rescue/organization information
Name:
Address:
Phone number:
Representative signature
Representative name (print) Date
Receiving rescue/organization information
Name:
Address:
Phone number:
Representative signature
Representative name (print) Date