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FAQ
Owner Surrender Request Form
Form Date
MM slash DD slash YYYY
Form Completed By
First Name
Last Name
Owner's Personal Information
Owner/Shelter Name
First
Last
Cell Phone
Email
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Dog's Information
Dog Name
Dog Pictures
(Required)
Drop files here or
Select files
Max. file size: 128 MB.
You may upload more than 1 picture. Please email any additional images you are unable to upload to intake@goldenretrievers.org
Dog's Gender
Unknown
Female, Unaltered
Female, Spayed
Male, Unaltered
Male, Neutered
Age
Weight
Where did you get the dog?
How long Owned?
Medical Information
Veterinarian's Name
Veterinarian's Office Phone Number
Are vet records for dog available?
YES
NO
If no, is owner willing to make a financial contribution to offset GRRNT's Costs?
YES
NO
Is dog current on all shots and vaccinations?
YES
NO
If no, is owner willing to make a financial contribution to offset GRRNT's costs?
YES
NO
Is dog on heartworm preventative?
YES
NO
If no, is owner willing to make a financial contribution to offset GRRNT's costs?
YES
NO
Additional Health Notes:
Behavioral Information
Why is the dog being given up?
Dog's reaction to children:
Dog's reaction to other dogs? Has the dog lived with other dogs?
Has the dog lived with cats? Dog's reaction to cats:
Any anxiety or fears?
Describe any type of anxiety or fear: Separation from owner, thunderstorm, car, fireworks, loud noises, etc.
House Trained:
Can the dog be Crated?
What is the dog's reaction to being in a crate?
Does dog like to swim?
How does the dog act on a leash?
Any formal dog training?
How does the dog ride in a car?
Has the dog ever shown aggression toward other dogs? If yes please explain.
Has the dog ever bitten another dog, or fought with another dog? If yes please explain.
Has the dog ever shown aggression toward people? If yes, please explain.
Has the dog ever bitten a person or snapped at a person? If yes please explain.
Describe the dog's personality and activity level.
How much exercise does the dog need?
Additional Behavioral Notes:
Other Information
What brand food do you feed the dog?
Additional Notes or Comments:
Is the dog microchipped?
Yes
No
Don't know
Microchip Number and Brand
Who is the microchip registered to?
Phone
This field is for validation purposes and should be left unchanged.
