German Shorthaired Pointer Care of Ohio Rescue

Surrender Form

9476 Seymour DriveStreetsboro, 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, o�cers, 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 DriveStreetsboro, 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?_____________________________________________