Contact Details:  
Today's Date
Releasing owner's name
Home Phone
Work Phone
Email address


I unconditionally release the beagle described below to Beagle Rescue Victoria Inc. I declare that the information provided herein is true to the
best of my knowledge.
Beagle's Details:  
Beagle's Name
Sex Male Female
Date of Birth (Age)
Please provide accurate dates for the latest vaccinations:
  C3 C5
  C4 Other
1. When did the beagle last have Flea / Worm / Heartworm medication?
Flea treatment
Worm treatment
Heartworm treatment
2. What type of Flea / Worm / Heartworm medication have you used?
Flea treatment
Worm treatment
Heartworm treatment
3. Do you have the receipts for the vaccinations?
If no, please provide the name of vet clinic where vaccines were given
4. Please attach below original paperwork of Desexing, Vaccination and Microshipping Certificates

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NOTE: This form requires an attachment to work.
If you don't have original paperwork available, please attach a photo of your beagle.

5. Please provide the details of your regular vet clinic:
6. Remarks to help us place your beagle (tick all that apply)
Well behaved?  
Good with other dogs?  
Good with cats?  
Good with children?  
leash trained?  
House trained?

7. Other important things that we should know that will help us place him / her
in the most suitable home:


8. Reason(s) for releasing beagle:


BRV will contact you shorlty once we process this application.

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