Surrender Form - GSP Care of Ohio

German Shorthaired Pointer Care of Ohio Rescue
Surrender Form
9476 Seymour Drive
Streetsboro, OH 44241
(330) 626-4234
I__________________________________________, do hereby surrender to German
Shorthaired Pointer Care of Ohio Rescue this German Shorthaired Pointer named
_________________________. I certify that I am the owner of this dog, free and clear of
all other interests. I certify that this dog is not possessed of any dangerous or vicious
propensities. The information I have provided about the history of this dog is true and
complete to the best of my knowledge.
I authorize German Shorthaired Pointer Care of Ohio Rescue to place this dog into a new
home of their discretion and according to their ability to locate a suitable owner. I
irrevocably relinquish to German Shorthaired Pointer Care of Ohio Rescue or its agents all
rights, title and interest in and access to the dog surrendered. I hereby hold harmless and
indemnify German Shorthaired Pointer Care of Ohio Rescue, its board of directors, its
members, officers, agents and volunteers from all claims, demands, actions, causes of
action and liability of any kind whatsoever arising as a result of or in connection with the
surrender and subsequent adoption or other disposition of the surrendered dog.
I certify that I have read, understand and willingly agree to the terms of this document
Signed_____________________________________
Date_______________
Name (Print)________________________________
Address__________________________________________________________________
City_______________________________________ State_______ Zip_______________
Phone_____________________________ Additional Phone_______________________
German Shorthaired Pointer Care of Ohio Rescue
Surrender Form
9476 Seymour Drive
Streetsboro, OH 44241
(330) 626-4234
Dog’s Name__________________ Sex _____ Birth date if known, approx. age if not______
Dog’s registered name and AKC number (if applicable)_____________________________
Where was the dog obtained?__________________Breeder if known_________________
Spayed/neutered?_______ Housebroken?________ Crate Trained?_________
Vaccinations? (list and date of last if known)_____________________________________
__________________________________________________________________________
Heartworm medication? (yes/no, brand)____________________ Date last given?_______
Last tested for heartworm and other worms?___________________
Physical problems/allergies____________________________________________________
How does the dog react to the following:
Other dogs______________________________ Cats_______________________________
Children______________________________Strangers______________________________
Walking on lead____________________________Riding in car_______________________
Being alone in yard____________________________
Being alone in house____________________________
What does the dog....
Like best______________________________ Dislike_______________________________
Fear____________________________
How does the dog react when frightened?_______________________________________
Has the dog ever bitten anyone?_________ If yes, please describe____________________
__________________________________________________________________________
Where does the dog sleep?__________________Spend the day?_____________________
What food does the dog eat, how much?________________________________________
Has the dog had any training? (Circle all that apply) Obedience, Field, Professional, Owner,
Other (describe)________________________
List commands, tricks, skills dog knows/has______________________________________
Dog’s bad habits: (Circle any that apply) digging, barking, chasing cars, soiling house,
jumping up, other (describe)______________________
Why are you surrendering this dog? ____________________________________________
Describe the ideal home for this dog____________________________________________
Anything else you want us to know?_____________________________________________