Release Form

Thank you for your interest in giving up your Airedale for adoption through Airedale Rescue Group. Please fill out this form completely. All fields are required. Also a cute picture or two should be emailed to us at info@airedalerescuegroup.com for the website. We serve North and South Carolina, Georgia, Tennessee, and Alabama and assist in other states as requested by Airedale Rescue groups serving that region.

If you are human, leave this field blank.

Name *

Telephone *

Alternate telephone

Address *

City *

State *

Zip *

Email *

Alternate email

Name of dog *

Male or Female? *

Male

Female

Neutered/ Spayed? *

Yes

No

Age/ Birthday *

AGE DD/MM/YYYY

AKC papers? *

Yes

No

Weight *

Reason for giving up Airedale

Dog currently lives with: * a) number of adults: b) if children, age of children: c) if pets or other animals, types and ages: d) other important living conditions:

Airedale is (check all that apply to your Airedale) *

Inside dog

Outside dog

Chews everything

Chained outside

Fenced yard

Uses dog door

Runs loose

Crate trained

Housebroken

Mean dog

Sweet dog

Good with kids

Bad with kids

Timid

Agressive

Loves cats

Hates cats

OK with cats

Loves dogs

Hates dogs

OK with dogs

Good on leash

Bad on leash

Digs

Loves grooming

Hates grooming

Runs away

Good in car

Bad in car

Bites

Good eater

Bad eater

Allergic to food

Special medical condition (fill in "any other medical treatment" field below)

Dominant to other household animal(s)

Aggressive to people/kids

Any other medical treatment

Dog's best qualities are: *

Dog's worst qualities are: *

Has Airedale received any obedience training? If yes, please describe. *

If you used a trainer, please supply name, address and telephone number

Has dog ever bitten anyone? If yes, please describe when and the circumstances *

Veterinarian's Name, Address and Telephone number. List whose name the records are under. *

Airedale was vaccinated and/or tested for * a) Rabies YR: b) DHLP-P date: c) Intestinal parasite exam; worms test date: Results & Treatment: d) Bordetella vaccine date: e) Heartworm test date: Results & Treatment, if any: f. Heartworm medication used: Last date given: g) Flea/Tick preventative used: Last date given: How often? h) Does your Airedale have a microchip? If yes, issuing company name and number:

Food Name: Amount: How often?

My dog has allergies to (check all that apply to your Airedale)

Wheat

Beef

Fish

Chicken

Dairy

Soy

Lamb

Corn

Other (describe below)

Other allergies

If dog receives supplements, describe what and how often

What kind of injuries has your dog had? Describe here *

What kind of medical issues has your dog had? Describe here *

What type of ongoing medication does your dog take, for what ailment? Describe here *

I certify ownership of the Airedale described above. This Airedale has not bitten any person or animal within 15 days and has not been exposed to rabies. I give complete ownership of the Airedale to Airedale Rescue Group and release its volunteers and representatives of all liabilities of said dog. I give my permission for volunteers to contact my veterinarian including if applicable Banfield Veterinary Clinic, groomer and trainer for information pertaining to this dog.

"Digital Signature": By submitting this form, I certify that the information provided on this form is true and accurate. * Full name: Date: