First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Cell Phone*

I acknowledge and completely agree that Paw Angels Inc. is providing assistance in a community support situation, and that the dog (name: ______ & description: ____) is not officially registered with the rescue. I recognize that Paw Angels Inc. is offering help with medical supplies, medical care, and other support, but they are unable to intake this dog. I understand that Paw Angels Inc. will assist if I am unable to keep the dog permanently and need to make further arrangements, but I realize that I cannot immediately return the dog to the rescue. In the box below type dogs name and give a brief description of the dog.*

I accept full responsibility for finding a suitable placement for the dog. I understand that a veterinary reference check and a home visit must be conducted, and that any new party must agree to return the dog to ______ if they are unable to keep it. Please type your initials in the box below. *