NW FL Great Dane Rescue

Surrender Form

 We are not currently able to receive on-line applications. Please complete this application and copy and paste it into an e-mail addressed to PGreatDaneRescue@aol.com, or fax it to 251-974-5777.

Name:

Street:

City: State: Please Select Your State Alabama Mississippi Florida Georgia Tennessee S. Carolina N. Carolina Virginia W. Virginia Louisianna Texas Zip:

Phone Number: Alt Phone:

Email Address:

DOG'S NAME:

Dog's Age:

Dogs Gender:

Dogs Color:

Is dog Spayed or Neutered: Please Choose... Yes No

Do you have AKC Registration papers on this dog? Please Choose... Yes No

Is the dog tattooed or Microchipped? Please Choose... Yes No

If Yes, Please Provide Tattoo Number, Registry Number, and Phone Number:

 

Veterinarian :

Address:

Phone Number:

Is the dog current on vaccinations? Please Choose... Yes No

Are you able to provide a complete medical record on this dog? Please Choose... Yes No

Has this dog ever bitten anybody? Please Choose... Yes No

If Yes, Please Explain:

 

Is Dog Housetrained? Please Choose... Yes No

Is dog good with children? Please Choose... Yes No

Is dog good with other pets? Please Choose... Yes No

Has the dog had basic obedience training? Please Choose... Yes No

Please explain why you are giving up this dog:

 

 

I agree and understand that I am giving up all rights of possession and ownership of the described dog. I agree and understand that this dog is now the sole property of NW FL Great Dane Rescue. I promise that the information I am giving is accurate, and that NW FL Great Dane Rescue will not be held liable or chargeable for any false information or misrepresentations that I may have submitted on this form. I further agree and understand that NW FL Great Dane Rescue will do whatever is necessary for the safety and well-being of this dog.

 

Previous Owner's Electronic Signature:

Driver's License Number: