1158 26 TH Street, Santa Monica, CA

90403
310.74-LHASA • 310.745.1551 Fax
LhasaHappyHomes@aol.com
RELEASE OF ALL CLAIMS
I hereby release to LHASA HAPPY HOMES RESCUE, this pet as described herein:

Dog’s name____Belle_______ Age ____5_______ Birthdate (if known) ____June 6___ Male Female

Weight ____19__ Color____White___ Breed _________Lhasa Apso________  Spay/Neutered ______2003_____(date)

Reason(s) you are giving up: ____Do not have the funds or time to car for her___________________________________

DOG INFO: Housebroken OK/dogs OK/Cats Good w/ kids Gives Kisses Protective*

Snappy* Food Aggressive Separation Anxiety Destructive/chews* Plays w/ toys Barker*

Uses Doggie Door Ok Alone during Day  Knows Commands* Good in the car Good on Leash
*Please explain –Protective and barker-Lhasa’s were bred to be alarm/guard dogs by barking at strangers ergo she barks
Commands she knows how to sit, stay, come, kiss, _____________________________________________________
Ever bitten anyone/drawn blood/stitches? Explain (please provide dates and circumstances) _____________________
_______________________________________________________________________________________________
Dog came from Friend Breeder Rescue Pet Store* *Have you contacted original breeder or rescue to let
them know dog needs to be rehomed? Yes No If not, why not? In Georiga__________________________
*Name of Pet Store purchased from ________________________________ Phone # ___________________________
Flea Control: Yes No Type: Frontline Advantage Revolution Last Given (date)_12/08__________
Shots Up to Date? Date Last rabies __10/08_____ DHLPP __10/08_______ Bordatella __10/08_________
Any special needs? Phenobarbital ___________________________________________________________
Has the dog received obedience training? Yes No Explain: ______________________________________
Brand of food? Pedigree____________ Wet Dry Feeding Time(s)/Amt Any______________________
Presently sleeps in Own Bed Human Bed Outside Other: _______________________________________
Is he/she microchipped? Yes No  Avid Home Again  Other # ___________________________
Any medical issues/on any medication: (Allergies, health history, etc) Phenobarbital b/d of epilepsy______________
________________________________________________________________________________________________

Best/Worst characteristics of your dog (including any “attitude”): Extremely loving and great happy demeanor, needs lots of love!

__________________________________________________________________________________________________________
 1158 26 TH Street, Santa Monica, CA
90403
310.74-LHASA • 310.745.1551 Fax
LhasaHappyHomes@aol.com
ANYTHING YOU CAN TELL US ABOUT YOUR DOG THAT WILL HELP US IN REHOMING:

She is perfect we cannot care for her b/c of 2 new babies and the time and money it takes to care for them____________________

__________________________________________________________________________________________________

What will you be sending along with the dog (food, bed, toys, crate, etc)? Crate, toys_________

__________________________________________________________________________________________________

Donation to Lhasa Happy Homes for spay/neuter/placement/shots/fostering: $____________

Upon my release of the above-mentioned pet, I agree to allow Lhasa Happy Homes Rescue (LHH) select a new home for this animal,
which they deem to be appropriate, without any involvement from me (as the former pet owner), unless agreed upon in advance. By
signing this document, I, being of lawful age, do hereby release, acquit and forever discharge LHH and their employees, agents
(hereinafter collectively designated as the releasees) of and from any and all allocations, causes of action, claims, demands on account
of or in any way growing out of any and all claims of any kind resulting, or to the result from, or by reason of the conduct of releasees
occurring at either any time prior hereto or hereinafter.

Further, by signing this document below, Lhasa Happy Homes certifies that it will foster and care for your dog(s) until such time as
they are re-homed with a permanent family. We will house and board, vet and medicate, spay/neuter if necessary, groom, de-worm
and provide a loving environment for your pet. We will not, under any circumstances, resell your animal for the purposes of medical
research or anything related thereof.

DOG’S NAME: BELLE____________________

Agreed to and accepted by ____________________________________on this ________day of ____________, 2006.

Name – Please Print Date Month

_______________________________________________ Email Address: _______________________________

Pet Owner (Releaser) Signature

________________________________________________ Phone: _____________________________________

Address

__________________________________________________________
City/State Zip

VETERINARIAN: __________________________________________
(name)
______________________________________________________
(Clinic)
PHONE ___________________________________________

IMPORTANT: Please attach copies of current shot records, sterility and rabies certificates and send along with a
signed copy of this Owner Release Form (OTI). Thank you.