Surrender a Golden Form | Golden Beginnings Golden Retriever Rescue

APPLICANT AND DOG INFORMATION

Owner Name*

First Last

Your Address*

Street Address Address Line 2 City State ZIP Code

Phone (cell)*

Secondary phone*

Email*

Dog's name*

Breed of dog*

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:*

Estimated age of dog*

How long have you owned this dog?*

Dog's gender*

Male
Female

Weight*

Color*

Markings*

Did you purchase this dog from a breeder?*

Yes
No

Name of Breeder

Where did you get the dog?

Veterinarian’s name*

Name of animal hospital*

Veterinarian's phone*

Has the dog been vaccinated for rabies?*

Yes
No

Date of last rabies vaccination?*

Has the dog been DHLPP vaccinated?*

Yes
No

Date of last DHLPP vaccination?*

Has the dog been vaccinated for bordetella?*

Yes
No

Date of last bordetella vaccination?*

Has the dog been on heartworm preventative?*

Yes
No

Date last heartworm preventative administered?*

Date of heartworm test?

RELEASE OF VETERINARY RECORDS

Will you provide vet records?*

Yes
No

Is the dog spayed/neutered?*

Yes
No

Does the dog have any physical problems?*

Does the dog have any allergies?*

Does the dog have a microchip? If known, list number.*

Is the dog take any medications? If yes, please list medications.*

DOG'S PERSONALITY INFORMATION

Does the dog have any obedience training? If so, what school/teacher?

List commands, skills, tricks:*

Is the dog housetrained?*

Is the dog crate trained?*

Who in the family does the dog obey?*

Where does the dog typically spend the day?*

Where does the dog typically spend the night?*

Brand of dog food fed (please indicate wet or dry)*

How often is the dog fed & how much?*

How does the dog react to other dogs?*

How does the dog react to cats?*

How does the dog react to strangers?*

Has the dog lived with children, and if so, what age(s)?*

How does the dog react to walking on a leash?*

How does the dog react to being alone in the yard?*

How does the dog react to being alone in the house?*

How does the dog react to loud noises?*

Does the dog bark excessively?*

Yes
No

Does the dog dig?*

Yes
No

Does the dog jump fences?*

Yes
No

Does the dog chew?*

Does the dog show shyness?*

Does the dog fight with other dogs?*

Does the dog growl when you take away food or toys?*

Does the dog snap or nip at people? If yes, please explain:*

Does the dog show fear of children?*

Does the dog show fear of men or women?*

Has the dog injured or killed another dog or animal? If yes, please describe:*

Has the dog ever bitten a person? If yes, please describe:*

Did the wound require medical attention?*

Yes
No
N/A - the dog has not bitten anyone

Was it reported to animal control?*

Yes
No
N/A - the dog has not bitten anyone

Why are you surrendering this dog?*

AGREEMENT

Please check the box to show you've read and agree with the following statement.

APPLICANT agrees:*

When an owner surrenders their dog to us, all ownership rights are relinquished to our organization.

Today's date.*

Current owner of the dog*

Please use your mouse or finger to sign.

Is there a co-owner?*

Yes
No

Co-owner of the dog*

Please use your mouse or finger to sign.

If you would like to make a donation to our organization, please click here. All donations are used solely for the care of dogs in our program.

NECESSARY DOCUMENTS

Along with your completed form, please attach
• Copy of all veterinary and shot records.
• AKC and/or Pedigree papers and registration if applicable.
• Please attach a photo of the dog.

Please attached your document(s) here.

If you have trouble attaching your documents for any reason, please email them us here: info@gbgrr.org

Drop files here or

Max. file size: 10 MB.

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Email

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