Relinquishment Application

Relinquishment Application
Applicant's Full Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Daytime Phone Number

Area Code Phone Number
Evening Phone Number

Area Code Phone Number
E-mail
Name of Dog(s):
Is he/she a purebred Chin? If not, what mix is your dog?
Gender
Spayed or Neutered
Age of dog(s)
Up to date on shots?
Brief description of the dog(s)
List all known behavioral issues
List all know health issues
Reason for re-homing
Is there anything else you'd like to share with us?
How soon are you looking to rehome your dog?
Enter the message as it's shown *
By clicking "Submit" I am hereby giving CJCR permission to contact the above references at the numbers provided. I attest all information I have provided above is true. Thank you for applying to adopt one of our dogs!
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