Dog release agreement
Please read this first
This form will be scanned by electronic equipment. It is important that you:
use a blue or black pen to mark your answers; and
print clearly.
This agreement provides for the voluntary handover of ownership of the dog to the Tararua District Council.
Completing this form does not mitigate any pound fees or dog registration fees that may be owed to Tararua District
tararua district council
26 gordon street
po box 115
dannevirke 4942
06 374 4080
Person details (Please print in CAPITALS)
Title: Mr Mrs Miss Ms
First names
Home phone number Mobile phone number NAR (only if dog owner)
Do you own the dog(s)? Yes No
If NO, please explain.
Being the owner or person deemed to be in charge of the dog(s), I hereby give my consent and voluntarily hand over the following
to Tararua District Council:
Dog name Breed Colour Sex Age Tag No. Dog ID
In handing over the dog(s) to the Tararua District Council, I understand that the Tararua District Council will assess the temperament
of the dog(s) and suitability for re-homing. If found to be unsuitable, or Council is unable to re-home the dog, it will be euthanised.
Is the dog(s) being released after uplifted under Section 71 of the Dog Control Act 1996?
Yes No
I have read and I understand my rights regarding this matter.
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Signature Date
click to sign
click to edit
dog release agreement2
Office use only
Dog re-homing information
Good points
Bad points
Type of home
Outcome: Re-homed Euthanised Registered owner collected
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Animal Control Ofcer
Authority updated by ACO on
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Archived by: Archived date
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