Heirloom Wheatens - Relinquish Form

Complete the form below if you are interested in reslinquishing a Soft Coated Wheaten Terrier. Once your completed application is received, it will be reviewed and one of the co-chairpersons will contact you to discuss your desire to relinquish. Because we invest our time and money in these rescues and placements, we would appreciate a donation when you relinquish your dog.

Be advised that completing this application is merely the first step in the process of relinquishing a dog. The GCSCWTC will review the form you submit and will make contact with you. Our initial contact with you is only part of our determination for acceptance. GDSCWTC has other considerations that are very important in this process and in making a final decision to rescue any dog.

When a wheaten is rescued, it spends time being evaluated and completing a number of medical checks. When it is ready to be adopted, we will match the dog to our list of applicants.

In order for our team to place your dog in the very best new home we need as much information as possible about your dog. Please tell us as much information as you can about your Wheaten. We require the lower portion of this form to be filled out completely before submitting.

In some cases our rescue efforts will be limited to helping make direct connection between our adoption applicants and those with dogs to relinquish.

Describe the situation or events that have caused you to relinquish your dog to rescue adoption:
Age:	Sex: Male Female
Spayed / Neutered? Yes No	Is your dog AKC registered? Yes No
How long have had this dog?	How did you acquire your Wheaten, and from whom?
Do you know the dog's pedigree?	Do you have other pets at home? Yes No If Yes, Describe them
Attitudes of your Wheaten:
Towards other Animals:
Towards Children:
Towards Men/Women:
Has the dog ever been aggressive toward or bit a person? Yes No	Has the dog ever been aggressive toward or bit another dog or animal? Yes No
House Trained:	Kennel Trained:
Professionally Trained:
Has your dog been to any training classes?	Does your dog have any titles?
Eating Habits:	Special Diets?
Medication or Suppliments?	Sleeping Habits:
Health
Do you have a regular veterinarian? Yes No	Name & Contact information for your Vet:
When was the last time your dog was into the Vet?	What was the reason for the visit?
Does your dog have any health problems?	Is your pet on medications on a regular basis? Yes No If yes, what is the condition being treated?
Is your dog groomed on a regular basis? Yes No	If yes, please supply the groomer's name and contact information.
What are your dogs likes and dislikes? (Chew bones, chase rabbits, dig holes, etc.)
What does your dog like to do? (Swim, walk, jog, play with the kids, etc.)
Provide a description of the "Day in the Life" of your dog.

I, AFFIRM THAT I have the legal right and authority to place my Soft Coated Wheaten Terrier called , identified by with the Greater Denver Soft Coated Wheaten Club, Inc. ("Greater Denver") if applicable. I do hereby transfer ownership and all rights, title and interests to said dog to Greater Denver and do further release Greater Denver and any person who may obtain the possession or ownership of said dog through it from any claim of any kind arising out of my title to or control of this animal.

I do further AFFIRM THAT to the best of my knowledge this dog has not bitten anyone within the last ten (10) days prior to surrender and to the best of my knowledge does not have a bite history. All information about the animal given by me to the Greater Denver Rescue is true.

ADDITIONAL COMMENTS:

CONTACT INFORMATION:
Name:
Phone:
Email:

Entering today's date, name, and address will be accepted as a signature.
A hard copy of this contract will need to be signed on delivery of dog.

SIGNATURE:
Date:
Owner:
Address: (City, State, Zip)

If you would like to print this form and mail it to us.

Please mail to:
GDSCWTC - Rescue
4925 S. Pearl St.
Englewood, CO 80113

A signed relinquish form will be required at the time of release.