DO NOT PRINT THIS FORM AND MAIL IT TO US. Please fill in the form online and submit it by clicking the 'save' button at the end.
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DOG SURRENDER APPLICATION
If you have found a Golden Retriever, please consult with local animal control officials regarding stray dog, ownership determination proceedings.
GRCGLA Rescue cannot take in stray dogs.
If you would like to relinquish your Golden Retriever to GRCGLAR, please fill in the form below and a volunteer will contact you within 48 hours.
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1. Name:
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2. Address:
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3. City:
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4. Zipcode:
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5. Phone number(s):
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6. Email:
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7. Name of dog:
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8. Breed of dog:
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9. Does anyone else have an ownership interest in this dog? If "yes" please provide the name, address and telephone numbers (home, work and cell phone numbers) of each person:
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10. Estimated age of dog:
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11. How long have you owned this dog?
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12. Sex:
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13. Weight:
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14. Color:
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15. Markings:
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16. Did you purchase from a breeder? If yes, name of breeder:
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17. If not from a breeder, from whom?
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18. Veterinarian (name/phone):
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19. Has the received DHLPP, bordetella and rabies vaccines in the past year? Can you prove this?
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20. Will you provide vet records?
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21. Is the dog spayed/neutered?
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22. Does the dog have any physical problems?
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23. Does the dog have any allergies?
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24. Is the dog on medication (please describe)?
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25. Does the dog have any obedience training? If so, what school/trainer?
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26. List commands, skills, tricks:
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27. Is the dog housetrained?
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28. Is the dog crate-trained?
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29. Who, in the family, does the dog obey?
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30. Where does the dog typically spend the day (loose in house, crated, garage, fenced yard, tied out, dog run)?
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31. How does the dog react to other dogs?
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32. How does the dog react to cats?
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33. How does the dog react to strangers?
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34. Has the dog lived with children? If yes, what ages?
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35. How does the dog react to walking on leash?
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36. How does the dog react to being alone in the yard?
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37. How does the dog react to being alone in the house?
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38. How does the dog react to surprises?
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39. How does the dog react to loud noises?
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40. Does the dog bark excessively?
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41. Does the dog dig?
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42. Does the dog jump fences?
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43. Does the dog chew?
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44. Does the dog show shyness?
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45. Does the dog fight with other dogs?
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46. Does the dog snap or nip at people? If yes, please explain:
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47. Does the dog growl when you take away food/toys?
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48. Does the dog show fear of children?
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49. Does the dog show fear of men or women?
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50. Has this dog injured or killed another dog or other animals? If yes, please describe:
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51. Has this dog ever bitten a person? If yes, please describe:
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52. Did the wound require medical attention?
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53. Was is reported to animal control?
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54. What does the dog like best?
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55. What does the dog fear most?
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56. Why is this dog up for adoption?
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All dogs placed through GRCGLA Rescue must be spayed/neutered and shots must be up to date. We may not be able to place this dog due to its age, health, physical condition, temperament or lack of training.
Please read, sign and date:
I, ________________________________, hereby make available for adoption through Golden Retriever Club of Greater Los Angeles Rescue this golden retriever named _______________who is (age) _________. I certify 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 and I have not willfully concealed information about this dog that may indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify Golden Retriever Club of Greater Los Angeles Rescue, its Board of Directors, foster home providers, volunteers and agents from all claims, demands, actions, causes of action or liability of any kind whatsoever arising as a result of or in connection with the adoption of the above named dog, and/or any harm or injury caused by such dog as a result of our offering such dog for adoption, or whatever kind or nature. I further understand and acknowledge that: (1) Despite my offering this dog for adoption, no such adoption may prove possible for this dog because of either terminal illness causing pain or over-aggressiveness toward people that cannot be cured; (2) GRCGLA Rescue may have no choice but to put this animal to sleep should either of those conditions obtain; and (3) my above release, discharge and agreement to hold harmless and indemnify GRCGLA Rescue, its Foster Home Providers, Volunteers, and agents will also extend to, and cover, those events that may occur after I have delivered this animal to GRCGLA Rescue for adoption through and until such time as this dog is put to sleep if adoption proves not to be possible for either of the above reasons.
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Signature required:
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Date:
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