owner surrender form
German Shepherd RESCUE of Central Texas
Please fill out this form to the best of your ability. Your honest answers will help us get to know the dog and give us background information needed for adoption. If a question does not apply to you then please put N/A in that space. The information will make sure that we are able to place the dog in a new home and/or foster care that is best matched with his/her personality and needs.
Owner Surrender to GSDrescueCTX Agreement
Today’s date:
General Information
Name of Dog:
Breed (mix or pure bred):
Gender: MALE FEMALE
Spayed/Neutered: YES NO
Color(s) of Dog:
Scars, Tattoos, or Injuries:
Heartworm positive or negative:
Weight of dog:
Coat condition:
Medical Information
Name of Veterinarian or Animal Hospital:
City/town:
State: Zip Code:
On Heartworm Preventative: YES NO
Current Rabies Vaccine: YES NO Date Of Last Rabies:
Current DHLPP Vaccine: YES NO Date Of Last DHLPP:
Current Bordetella Vaccine: YES NO Date Of Last Bordetella:
Animal Care
Types or Brands of Dog Food:
How often is the Dog fed:
Once Daily
Twice Daily
Free Fed
Eating regularly: YES NO
Normal stool: YES NO
Other:
Behavior
How is the dog with dogs of all sizes?
How is the dog with other male and female dogs?
Has the dog been around other dogs and people- is he socialized?
How is the dog with cats?
What age child has the dog been around and how did the dog behave?
Has the dog ever bitten or nipped anyone or had a bite report?
Does the dog like to be outside or inside?
Is the dog house trained?
Crate trained?
Has the dog received any formal training and if yes then with who and what type of training?
What commands does the dog know?
Did he perform them at evaluation if one was administered?
How long has the person surrendering had the dog?
Is this dog their own personal dog?
What is the primary reason for surrender?
RELEASE OF OWNERSHIP
I agree and understand that I am giving up all rights of possession and ownership of this dog and that I will not be able to redeem said dog at any time nor will I be allowed to know the dog's whereabouts. I agree and understand that said dog is now "sole property" of GSDRESCUECTX. I promise that the information that I am giving is accurate and that the rescue will not be held liable or chargeable for any false information or any misrepresentations that I may have submitted on this form. I further agree and understand that rescue will evaluate this dog to determine whether or not the dog being surrendered will be considered "adoptable". The rescuers cannot guarantee placement. I also sign this give up agreement honestly and state truthfully that this animal has never bitten any human being.
Surrendering Owner Information
Printed Name Of Previous Owner:
Signature of Previous Owner:
Street Address:
City:
State: Zip Code:
Phone Number with Area Code:
Driver’s License#:
Date of Birth:
Signature of GSDrescueCTX Representative (if in person):
Please consider making a donation now to help us care for this pet during his or her stay with us.
Your donation will go to cover food, shelter, medical, and other adoption vetting expenses.
If the dog is heart worm positive the treatment can be as much as $400
Thank you for relinquishing this dog to a reputable rescue rather than abandoning it or taking in to a kill shelter. Please send any future forms/vet records/communication or donations to:
German Shepherd Rescue of Central Texas
PO Box 3184
Cedar Park, Texas 78630
WWW.GSDRESCUECTX.COM E-mail is [email protected]
Please fill out this form to the best of your ability. Your honest answers will help us get to know the dog and give us background information needed for adoption. If a question does not apply to you then please put N/A in that space. The information will make sure that we are able to place the dog in a new home and/or foster care that is best matched with his/her personality and needs.
Owner Surrender to GSDrescueCTX Agreement
Today’s date:
General Information
Name of Dog:
Breed (mix or pure bred):
Gender: MALE FEMALE
Spayed/Neutered: YES NO
Color(s) of Dog:
Scars, Tattoos, or Injuries:
Heartworm positive or negative:
Weight of dog:
Coat condition:
Medical Information
Name of Veterinarian or Animal Hospital:
City/town:
State: Zip Code:
On Heartworm Preventative: YES NO
Current Rabies Vaccine: YES NO Date Of Last Rabies:
Current DHLPP Vaccine: YES NO Date Of Last DHLPP:
Current Bordetella Vaccine: YES NO Date Of Last Bordetella:
Animal Care
Types or Brands of Dog Food:
How often is the Dog fed:
Once Daily
Twice Daily
Free Fed
Eating regularly: YES NO
Normal stool: YES NO
Other:
Behavior
How is the dog with dogs of all sizes?
How is the dog with other male and female dogs?
Has the dog been around other dogs and people- is he socialized?
How is the dog with cats?
What age child has the dog been around and how did the dog behave?
Has the dog ever bitten or nipped anyone or had a bite report?
Does the dog like to be outside or inside?
Is the dog house trained?
Crate trained?
Has the dog received any formal training and if yes then with who and what type of training?
What commands does the dog know?
Did he perform them at evaluation if one was administered?
How long has the person surrendering had the dog?
Is this dog their own personal dog?
What is the primary reason for surrender?
RELEASE OF OWNERSHIP
I agree and understand that I am giving up all rights of possession and ownership of this dog and that I will not be able to redeem said dog at any time nor will I be allowed to know the dog's whereabouts. I agree and understand that said dog is now "sole property" of GSDRESCUECTX. I promise that the information that I am giving is accurate and that the rescue will not be held liable or chargeable for any false information or any misrepresentations that I may have submitted on this form. I further agree and understand that rescue will evaluate this dog to determine whether or not the dog being surrendered will be considered "adoptable". The rescuers cannot guarantee placement. I also sign this give up agreement honestly and state truthfully that this animal has never bitten any human being.
Surrendering Owner Information
Printed Name Of Previous Owner:
Signature of Previous Owner:
Street Address:
City:
State: Zip Code:
Phone Number with Area Code:
Driver’s License#:
Date of Birth:
Signature of GSDrescueCTX Representative (if in person):
Please consider making a donation now to help us care for this pet during his or her stay with us.
Your donation will go to cover food, shelter, medical, and other adoption vetting expenses.
If the dog is heart worm positive the treatment can be as much as $400
Thank you for relinquishing this dog to a reputable rescue rather than abandoning it or taking in to a kill shelter. Please send any future forms/vet records/communication or donations to:
German Shepherd Rescue of Central Texas
PO Box 3184
Cedar Park, Texas 78630
WWW.GSDRESCUECTX.COM E-mail is [email protected]