German Shepherd Rescue and Adoptions

Dog Surrender Application

 

Please complete this form as thoroughly and accurately as possible, this will help us determine if the dog is a suitable candidate for our program.  Any inaccurate or incomplete information may be grounds for denial.  We are only accepting applications from North Carolina at this time.

Please understand that we are an all volunteer organization and that it may take 7-10 days to get back to you regarding your application.  In addition, once we decide to take a dog in it takes time to find a foster home and arrange transport.  Typically it is not an extremely quick process so if you are needing to rehome your pet within a very short amount of time (ie 2 days or 1 week), we may not be your most viable option.

 

OWNER / RESCUER INFORMATION
First Name
Last Name
Address
City
State
Zip Code
Home Phone
Work Phone
E-mail Address (please include an e-mail address as that is our primary form of communication).
Preferred Method of Contact

 

DOG INFORMATION
Is this your dog or one you found?
How long have you had this dog?
Is the dog a purebred GSD? Yes    No    Not Sure
Name of dog? (if known)
Sex of dog? Male  Female
Age of dog? (if known, or closest guess)
Is the dog fixed? Yes    No    Not Sure
Is the dog house trained? Yes    No
Is the dog crate trained? Yes    No
Is the dog an inside or outside dog? Inside    Outside    
Does the dog get along with other dogs, cats, and/or children?  Please Explain.
How does the dog react when left alone?  (ie separation anxiety, destructive, etc.)
Is the dog afraid of anything in particular? (ie men, brooms, thunder, etc)
Does the dog like to ride in the car? Yes    No    Not sure
Describe any training the dog has had, or tricks it has learned
Has this dog EVER bitten any other animal? Yes    No
If yes, under what circumstances?  Please describe completely.
Has this dog EVER bitten a person that you are aware of? Yes    No
If yes, under what circumstances?  Please describe completely.
Where did you find the dog, or, if you own it, where did it come from?
If this was a stray, was the dog wearing a collar? Tags? Have a tattoo? Please describe in detail.
If a stray, what steps have you taken to find the owners?  Please check all that apply.  

Posted flyers where the dog was found  

Posted an ad(s) in the local paper(s)  

Notified the local animal shelter(s)   

Had the dog scanned for a microchip  

Checked with local vet clinics   

Other (Please Explain)  

If this is your dog, what steps have you taken to re-home him/her?  Please check all that apply.  

Spoke to the breeder of the dog about re-homing

Advertised locally

Advertised on the internet

Spoken to other rescue group(s)

Other (please explain)
If this is your dog, why does it need to be re-homed?  Please explain in detail.
If this is your dog, what steps have you taken to resolve the problem without re-homing?  What can we do which might help you to keep the dog?

 

DOG'S MEDICAL INFORMATION
If you own the dog, is it up to date on vaccinations and heartworm preventative? Yes    No
What is the name and phone number of the dog's veterinarian?
What is the date of the dog's last vet visit?
If this is a stray have you taken it to a vet? Yes    No
What, if any,  treatments were given?
Please list all medications that the dog is currently taking.
What is the dog's physical health and condition?  Please describe ANY known health problems completely.
Are you willing and able to contribute financially toward medical care (including spay/neuter) or boarding for this dog? Yes    No
How long can this dog safely stay where it is?