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Animal Placement Form
Name_________________________________________________________
Address__________________________________
Telephone_____________________
City, State,Zip_____________________________ Date________________
Pet's Name_______________________________ cat dog rabbit other
(circle one)
Breed___________________________________
Color(s)___________________________
Sex _________ spayed/neutered or unaltered
Birthdate___________________
Declawed Y N Weight_______________ Housebroken/litterbox trained Y N
Date of last vaccinations:______________________________
Vaccinations given:___________________________________
Rabies tag number:___________________________________
Pet's current veterinarian:
_______________________________________________
Diagnosed Health problems, special diets, or medications
______________________________________________________________
__________________________________
Please describe pet's temperment (i.e. good with kids, others of its own
kind,
etc):__________________________________________________________
______________________________________________________________
___________
Reason for giving pet up for adoption:
______________________________________________________________
To the best of my knowledge, this is a true and accurate
description and statement of my pets health.
By signing this form, I give consent for MERLIN'S REFUGE to seek a new home
for the pet described above.
INDIVIDUALS REFERRED TO ME BY MERLIN'S REFUGE WILL NOT BE CHARGED ANY FEES TO VIEW THE PET DESCRIBED ABOVE. INDIVIDUALS
REFERRED TO ME BY MERLIN'S REFUGE WILL NOT BE ASKED FOR ANY FORM OF COMPENSATION FOR ADOPTION OF THE PET
DESCRIBED ABOVE.
Signature of pet owner
_______________________________________________
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