774 Mays Boulevard #10-359 - Incline Village, NV 89451

Phone/fax (775) 833-2066  

PamelaJoWolflady2@sbcglobal.net  - www.LakeTahoeWolfRescue.com  





Name  ___________________________________________________________________ Age __________ 


Address _______________________________________________________________________________


City/State/Zip ___________________________________________________________________________ 


Home Phone __________________________ Cell_____________________ Work_____________________ 


E-mail _________________________________________________________________________________


Name of dog ____________________________ Breed _________________ Sex ____ Age ______ Alt  ____


Microchip ___________________  Prior Vet  ___________________________________________________ 


Current Vet _____________________________________________________________________________ 


Driver’s License No. _______________________________________________________________________          



I understand and acknowledge that Lake Tahoe Wolf Rescue [LTWR ] cannot guarantee the behavior or health of any animal in the foster program and no statements made by Pamela Hormiotis or her representatives should be taken as a promise or guarantee. I hereby accept possession of this animal at my own risk and release and waive any right or claim which I may have now or which may arise in the future against Pamela Hormiotis, LTWR or their agents, for injuries to persons or damages to property caused by this animal.


Lake Tahoe Wolf Rescue reserves the right to conduct home visits prior to or following placement of an animal into the foster care program. LTWR reserves the right to reclaim an animal and terminate this Agreement if unsuitable home conditions, evidence of neglect, escape, and/or mistreatment of the animal is found.  


I agree not to leave this animal unattended on a runner or tether for any length of time, and to provide for it until permanent adoption is found, or until the animal is reclaimed by LTWR .


I agree that I will immediately notify LTWR if: 

·         Animal escapes 

·         any concerns occurs with the animal [misconduct with other animals in the home, etc.] 

·         the animal is ill, not eating, injured, or needs veterinary care for any reason 

·         the animal will be left under someone else’s care for any reason 

·         I promise to keep a tag on the dog with LTWR contact info. 



Signed ____________________________________________________________ Date _________________ 



Witnessed by_____________________________________________________________________________ 

                                    Pamela Hormiotis or Representative of Lake Tahoe Wolf Rescue