OWNER SURRENDER

I HEREBY DECLARE THAT I AM THE LEGAL OWNER OF THE ABOVE DOG AND WILLINGLY SURRENDER THIS ANIMAL TO GOING TO THE DOGS RESCUE FOR THE PURPOSE OF FINDING IT A NEW, PERMANENT HOME. I UNDERSTAND I AM RELINQUISHING MY PRESENT AND FUTURE RIGHTS AND CLAIMS TO THIS ANIMAL AND ITS POSSESSIONS LISTED HEREIN WHICH ARE BEING SURRENDERED ALONG WITH THE ANIMAL TO ENSURE THE ANIMAL'S CONTINUED HAPPINESS AND WELFARE. I UNDERSTAND THAT I MAY NOT BE PROVIDED WITH INFORMATION ABOUT THIS ANIMAL'S WHEREABOUTS AFTER ITS SURRENDER, BUT AM ASSURED IT WILL RECEIVE A LOVING AND PERMANENT HOME AND WILL NOT BE USED FOR ANY BREEDING PURPOSE OR MEDICAL OR SCIENTIFIC EXPERIMENTATION. I FURTHER ATTEST TO THE BEST OF MY KNOWLEDGE, THIS ANIMAL HAS NO PHYSICAL OR EMOTIONAL PROBLEMS OR HANDICAPS THAT WOULD MAKE IT UNSUITABLE AS A FAMILY PET. ALL STATEMENTS MADE HEREIN BY ME ARE TRUE AND COMPLETE TO THE BEST OF MY ABILITY. I AM ALSO AWARE THAT THERE IS A $75 SURRENDER FEE ASSOCIATED WITH SURRENDERING MY PET TO GTTDR.

* Required

Electronic Signature *

Date: *

Owners Full Name and Physical Address *

Owners Telephone Number *

Owners Email *

Owners Veterinarian for Surrendered Dog: *

Name of Dog *

Breed of Dog *

How old when you acquired dog? *

Age of dog (approximate or full dob if known) *

Sex/Gender *

Male
Female

Approximate Weight *

Is the dog housetrained? Explain if needed *

Does it potty on a leash or run free? *

Has the dog had previous owners? *

How does your dog spend the majority of its time? *

Is your dog indoor or outdoor mostly? Explain *

Is the dog exercised: *

Daily for at least 10 minutes
Daily for at least 45 minutes
Weekly when we can find time
We have not set aside time to walk or exercise dog
Occasionally maybe 2-3 times a month

What is your dogs feeding schedule? *

What are your dogs favorite toys?

Where does your dog sleep? Check all that apply *

Has your household changed since acquiring dog? Explain *

Does your dog enjoy children? Please be specific on behaviors *

PLEASE DESCRIBE YOUR DOGS INTERACTION WITH OTHER ANIMALS IN THE HOUSEHOLD:

DESCRIBE HOW YOUR DOG BEHAVES AROUND OTHER DOGS *

WHY DID YOU DECIDE TO ACQUIRE A DOG? *

COMPANION
FOR CHILD
FOR PROTECTION
Other:

DESCRIBE YOUR DOG'S BEHAVIOR AS A PUPPY. ANYTHING UNUSUAL?

HAVE YOU OWNED OTHER DOGS IN THE PAST? *

YES
NO

DESCRIBE YOUR DOG'S REACTION TO BEING LEFT ALONE? *

DESCRIBE YOUR DOG'S BEHAVIOR WHEN YOU RETURN HOME? *

DO YOU USE A CRATE? IF YES, WHEN DID YOU BEGIN TO CRATE YOUR DOG? *

HOW MANY HOURS A DAY IN A CRATE? *

LESS THAN 5HRS
LESS THAN 10HRS
NEVER CRATED

HAS YOUR DOG EVER BEEN TO OBEDIENCE SCHOOL? *

YES
NO

DOES YOUR DOG COME WHEN CALLED?SIT OR LIE DOWN ON COMMAND? *

DOES YOUR DOG PULL WHEN WALKED? *

WHAT IS YOUR DOG'S MOST UNDESIRABLE BEHAVIOR? *

WHEN DID YOU FIRST NOTICE THE PROBLEM? *

RANK THE SEVERITY OF THE PROBLEM *

MILD
MODERATE
SEVERE

HOW OFTEN DOES THE PROBLEM OCCUR? *

FREQUENTLY
OCCASIONALLY
RARELY

HAS THERE BEEN A RECENT CHANGE IN FREQUENCY OR SEVERITY? *

YES
NO

HAVE THERE BEEN ANY CHANGES IN THE HOUSEHOLD THAT COULD HELP TO EXPLAIN THE *

WHY DO YOU THINK THE DOG IS EXHIBITING THE BEHAVIOR PROBLEM?

DOES YOUR DOG EXHIBIT AGGRESSION OR THREATEN FAMILY MEMBERS? *

DESCRIBE EPISODES OF AGRESSION *

DOES YOUR DOG OVERREACT TOWARD GROOMING /HANDLING EFFORTS? *

YES
NO

IS YOUR DOG AGGRESSIVE TOWARD NON FAMILY MEMBERS? *

YES
NO

DESCRIBE THE DOG'S REACTIONS (GROWLS, GLARES, BARES TEETH, BARKS , BITES)UNDER THE FOLLOWING CONDITIONS: *

HOW OLD WAS YOUR DOG WHEN IT EXHIBITED THE FIRST SIGNS OF AGGRESSIVENESS?

IS THERE ANYONE WHO THE DOG IS NEVER AGGRESSIVE TOWARDS?

DOES YOUR DOG SUFFER FROM ANY PHYSICAL CONDITION THAT MIGHT EXPLAIN ITS AGGRESSIVENESS?

IS YOUR DOG MORE AGGRESSIVE TOWARD MALES OR FEMALES?

HAS YOUR DOG EVER KILLED ANY ANIMALS?

DOES YOUR DOG SHOW SIGNS OF FEAR PRIOR TO BECOMING AGGRESSIVE?

DESCRIBE THE SEVERITY OF PAST BITES:

IS IT ACCUSTOMED TO USING A DOGGIE DOOR? *

YES
NO

IS IT ACCUSTOMED TO USING A PUPPY PAD? *

YES
NO
NOT NEEDED-HOUSETRAINED

SPAYED/NEUTERED? *

YES
NO

IF NOT SPAYED/NEUTERED, WHY NOT?

MICROCHIPPED? *

YES
NO

LAST ANNUAL SHOTS? *

LAST RABIES SHOT? *

LAST ANNUAL EXAM *

HAS YOUR DOG BEEN HEARTWORM TESTED? *

YES
NO
YES BUT MORE THAN 2YRS AGO

RESULT OF HW TEST IF DONE

IS YOUR DOG ON HEARTWORM PREVENTATIVE? *

YES
NO

LAST TIME TREATED FOR FLEAS/TICKS? *

ANY MEDICATIONS FOR YOUR DOG? *

BEEN HOSPITALIZED OR TREATED FOR MAJOR INJURY? EXPLAIN *

DOES YOUR PET TRAVEL WELL IN A CAR? *

YES
NO

WILL IT LET YOU CUT IT'S NAILS? *

YES
NO

LIST OF POSSESSIONS TRANSFERRED WITH PET: *

CAN YOUR PET CLIMB STAIRS?