Montana German Shepherd Rescue
Surrender Form email@example.com
Instructions: Please read this Agreement, fill in the blanks, sign it and return it to Montana German Shepherd Rescue. Please do not omit information about your dog in order to get a home for him/her! The information is vital so we can find a suitable match for your dog’s disposition, age and health. Please give us the dog’s veterinary records if available and all collars, tags, bowls, toys, favorite blanket, and preferably a week’s supply of his current food when you surrender him, to help him acclimate to his new surroundings.
In consideration of the mutual promises contained in this Agreement, and other good and valuable consideration, intending to be legally bound, Montana German Shepherd Rescue and the undersigned (“you”) agree to as follows: 1. Permanent Surrender: You are permanently surrendering to us the dog described; Name of dog_____________________________________________________ Age _______DOB____________ Male ___ Female___ Spayed/Neutered __Yes __No Distinguishing Characteristics _________________________________________ You agree that you, your spouse and or co-owners, if any, are irrevocably transferring and relinquishing to us legal ownership of the dog on the date of the surrender. This gives us complete authority to take whatever actions in our sole judgment are necessary and in the best interest of the dog. 2. Pet Information: You are providing the following information about the dog, which you promise is true, complete and correct on the date of this Agreement. Please explain your answers on blank lines. General Information Are you the owner? _____Yes ____No If not, do you know what happened with the prior adoption? __________________________________ Name and address of the prior owner_________________________________________________________ Was your dog from a breeder? _____Yes____No. Breeder’s name_________________________________ Did you call the breeder for help finding a home? _____Yes ____No His/Her response? __________________________________________________________________________ Do you have registration papers for the dog? _____Yes ______No Was your dog purchased from a _____store ___shelter ____or? _________________ Why are you surrendering your dog? _________________________________________________________ How long did you own this dog? ___________________________________________ Did you try to find a new home for the dog on your own? _____Yes _____No Does your dog have: __Tattoo __Microchip __Neither __Not Sure? Health Information Spayed/neutered- Date ______________________________ Veterinarian __________________________Phone________________City/State_____________________ Is your dog current on vaccinations? ____Yes _____No
Last vet visit______________Last de-worming_____________________________ Distemper Vaccination date______________Rabies Vaccination date_________________________ You agree to direct your veterinarian to release the veterinary records for the dog to us? ______Yes_________No Has your dog been diagnosed with and/or treated for any of the following :( check all that apply) __Allergies __Asthma __Epilepsy/seizures __Urinary Tract Infection __Diabetes __Cancer __Arthritis __Thyroid Disease __Organ Failure __Parvo __Tumors __Bloat __Mange __Heart Murmur __Other (Please Detail) ______________________________________________________________________ Has your dog been hit by a car, injured, or required other surgery? __Yes __No If Yes, please explain _______________________________________________________________________ Behavior Information How would you describe your dog most of the time? (Check all That apply) __Very active __Couch potato __Talkative __Quiet __Playful __Friendly to family __Shy to family __Escape Artist __Friendly to visitor’s __Shy to visitor’s __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 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? How is dog with livestock? __Good __Has worked livestock __Chases __Has killed __Not sure? Housebroken? __Yes __No __Somewhat If somewhat, does dog... __Lift leg __urinate when excited __urinate in crate __Have accidents when left too long __can’t be trusted alone __Other (explain) ____________________________________________________________________________ Any bad habits? ___Yes __No If yes, please explain.__________________________________________ Does dog __Bite ___ Hide ___Jump up ___Cower Most appealing traits ________________________________________________________________________ What, if anything, is dog afraid of? _________________________________________________________ What, if anything, has dog been aggressive towards? __________________________________________ Where does dog spend the day? ________________________________________________________________ Where does dog sleep at night? ______________________________________________________________ Favorite games/toy __________________________________________________________________________ Has dog had any obedience training? __Yes __No __Not sure? If yes, what kind of training was it? __Punishment __Positive reinforcement __Food/Treat reward __Clicker __Leash Correction __E-collar __Pinch Collar __Other_________________________ Is dog crate trained? __Yes __No What commands does dog know? __Sit __Stay __Down __Off __Heel __Come __Other ________________ Does dog jump fences? __Yes __No If yes, how high? _________ Does dog dig under fences? __Yes __No Has dog ever bitten a person? ___Yes ___No Was medical attention required? __Yes __No ___N/A Was animal control involved? __Yes __No If yes to any please explain in detail: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ 3. Sterilization; If the dog has not been sterilized, you agree it must be spayed or neutered by us or you before it can be placed in a new home. We do not place dogs in new homes until they are sterilized. __________ (initial for agreement) 4. Stray; For a stray or undomesticated dog, you are providing the following additional information, which you promise is true and correct on the date of this Agreement: Date found ______________ Location dog was found? _______________________________________ Does it live in or around your home or garage or elsewhere? ______________________________ Any information about who might own the dog? ____________________________________________ Is there evidence that the dog is suffering from any bites, wounds, or other injuries? __________________________________________________________________
Does it growl or bare teeth? ______________Attack or bite? __________________ 5. No Guarantees. We will foster the Dog while we try to find a good home for it. representations or guarantees about our arrangements for the Dog. We make no
6. No Liability. We are not liable to you for any losses, injuries, damages, costs, expenses or liabilities whatsoever sustained or incurred by you in connection with your surrender of the dog, and our subsequent adoption, foster, or other arrangements for the Dog. 7. Entire Agreement, Modifications, Binding Effect. This written Agreement contains the sole and entire agreement between Montana German Shepherd Rescue and you, and supersedes any other agreements between you and us with respect to the subject matter of this Agreement. No modifications of this Agreement will be valid unless in writing duly signed by both you and us. This Agreement will be binding on our and your respective heirs, personal representatives, executors, successors and assigns.
8. Owner’s Release. The undersigned ________________(your name), who is/are the legal owner(s) of ___________________(name of dog); hereby transfers unto Montana German Shepherd Rescue all of my/our interest in said Dog. Including any registration papers, medical records, and any medications. It is my/our understanding that upon execution of this Release, Montana German Shepherd Rescue will have authority to do what is in the best interest of said dog and upon execution of this Release, _______________(name of Dog) becomes sole property of Montana German Shepherd Rescue, and I/We have no further rights, title or interest in said Dog.
Print Name; ________________________________________ Date: _______________________ Signature: _________________________________________
Print Name; ________________________________________ Date: _______________________ Signature: _________________________________________ Mailing Address: _________________________________________________________________ City _________________________ State _____________________ Zip _____________ Physical Address: _________________________________________________________________ City _________________________ State _____________________ Zip _____________ Home phone: _____________________________________ Cell phone: _____________________________________
Email address: ___________________________________________________