Surrender Form

Upload #1 of 3 Recent Photos of Your Dog:

What is the Primary Reason You Want to Surrender Your Dog?

How Does Your Dog Alert You if it Needs to go Outside?

How Many Meals Does Your Dog Have Per Day and When?

Heartworm Preventative Last Test Date:

Last Vaccination Dates for Annual DA2PP, Rabies, Bordatella, Corona: *

Monthly Preventative Medicines Given (type, brand, day of month for each) *

Your Veterinarian's Name and Phone Number : *

Dog's Color(s): *

Spayed/Neutered?: *

Yes

No

Dog's Gender: *

Male

Female

Dog's Breed: *

If There Are Children in the Dog's Current Home, What Ages? *

City: *

Street Address: *

Name: *

Email: *

Daytime Phone Number: *

Date Available for Surrender *

Date Signed (mm/dd/yyyy)

Signature (Typed Name) and Legally BInding: *

Please Provide Additional Comments/Details You Feel May Assist Uus in Placing Your Dog:

Upload #3 of 3 Recent Photos of Your Dog:

Upload #2 of 3 Recent Photos of Your Dog:

Please Provide Additional Details of Positive or Negative Behavior for the Next Owner: *

Has Your Dog Displayed Fear of:

Strangers

Thunder

Noise

Other Dogs

Has Your Dog Ever Bitten a Person or Other Animal? *

Yes

No

Has Your Dog Ever Snarled or Snapped at a Person or Animal? *

Yes

No

Dog's Nickname(s) - if any:

Dog's Name: *

Dog's Age When Acquired (years, months): *

State: *

Cell Phone Number:

Where Does Your Dog Stay if the Family Travels?

Where Does Your Dog Stay When The Family is Asleep?

Where Does Your Dog Stay When No One is Home?

How Many Hours Is Your Dog Used to Being Alone?

Describe Current Status Plus Past Evaluation, Date and Treatment of Each Issue:

How did you find The Grayter Good Inc?:

Strangers

Thunder

Noise

Other Dogs

Describe Your Dog's General Temperament? *

Dog's Age (years, months): *

Dog's Weight: *

Number of Adult Residents in the Dog's Present Home?: *

Zip Code: *

Surrender Request Form

The Grayter Good Weimaraner Rescue