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Owner Surrender Agreement
Owner Surrender Agreement
Green Dogs Unleashed
2015-06-21T20:17:15-04:00
Your Name
*
First
Last
Email
*
Date
*
Date Format: MM slash DD slash YYYY
Animal Name
*
Species
Animal ID #
Age
Breed
Sex
Male
Female
Spayed/Neutered
Yes
No
Has your pet bit or scratched a person in the last ten (10) days?
Yes
No
In what city?
Surrender History
Why are you surrendering your pet? Please provide as much info as you can; it helps us better care for your pet.
If we could help you resolve issues with your pet, would you be interested in keeping the animal?
Yes
No
Would need:
How long have you owned the animal?
How many homes has the animal had?
Where did you get the animal?
GDU
Shelter
Pet Store
Newspaper
Breeder
Friend/Relative
Found as a stray
Born in my home
Does your animal have:
Tattoo
Microchip
None
Not Sure
Medical Information
Has your animal been to a veterinarian?
Yes
No
Veterinarian
First
Last
City & State
Is he current on vaccinations?
Yes
No
Not sure
Has your pet been hit by a car, injured, or required other surgery?
Yes
No
Not sure
If yes, please explain:
Has your pet been diagnosed with and/or treated for any of the following:
(Check all that apply)
Allergies
Asthma
Epilepsy/seizures
Urinary tract infection
Diabetes
Cancer
Upper respiratory infection
Thyroid disease
Organ failure
Parvo
Tumors
Bloat
Arthritis
Mange
Heart murmur
General Personality
How would you describe your animal most of the time?
(Check all that apply)
Very active
Couch potato
Talkative
Quiet
Playful
Friendly to family
Escape artist
Shy to family
Friendly to visitors
Shy to visitors
Affectionate
Fearful
Independent
Fearless
A clown
Aloof
Withdrawn
Solitary
Loves kids:
Under 5 yrs
5-12 yrs
12-18 yrs
No patience with kids
Not sure how he his with kids
Good with men?
Yes
No
Not sure
Good with women?
Yes
No
Not sure
Good with cats?
Yes
No
Not sure
Good with dogs?
Yes
No
Not sure
What is the animal's favorite toy?
What brand of food has he been eating?
Food type:
Canned
Dry
Where does he like to sleep?
What, if anything, is he afraid of?
What, if anything has your animal been aggressive towards?
Dogs
How is your dog with livestock?
Good
Has worked livestock
Chases
Has killed
Not sure
Has he had any obedience training?
Yes
No
Not sure
If he has been trained, what kind of training was it?
Punishment
Positive
Reinforcement
Food/treat rewards
Clicker
Leash correction
E-collar
Other
Is he crate trained?
Yes
No
What commands does the dog know?
Sit
Stay
Down
Off
Heel
Come
Other
Does he come when called?
Yes
No
Has he been used for hunting?
Yes
No
Does he jump fences?
Yes
No
If yes, how high?
Does he dig under fences?
Yes
No
Is he house trained?
Yes
No
Somewhat
If somewhat, does he...
lift his leg?
urinate when he's excited?
urinate in his crate?
have accidents if left too long?
cannot be trusted alone?
other
How does he let you know when he/she has to go to the bathroom?
Where is he kept during the day?
At night?
Yes
No
Has he ever bitten a person?
Yes
No
If yes, did it break the skin?
Yes
No
Was animal control involved?
Yes
No
If yes to any, please explain in detail:
Is there anything else a future owner should know about your pet?
Surrender Agreement: I certify that I am the owner of or have the authority to surrender the animal described to GDU. I hereby relinquish all rights of ownership and any right to information on the disposition of the animal described to GDU. I also authorize the release of any veterinary records regarding the animal. I certify that to the best of my knowledge I have disclosed all of the information about the animal concerning health, behavior, history and anything else that may affect the safe placement of the animal in a new home.
Signed (enter your full name)
*
Date
*
Date Format: MM slash DD slash YYYY
Name
*
First
Last
Phone
*
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
If you are able,
please consider making a donation now
to help us care for your pet during his or her stay with us. Your donation will go to cover food, shelter, medical and other expenses.
Thank you for bringing your pet to a rescue – we know it was a tough decision for you.
Phone
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