Surrender Application

Please read the Surrender Guidelines prior to completing this application. Please answer the questions honestly and be as detailed as possible. This will help is in determining if we will be able to accept your dog in to our rescue.  Please note that shelter dogs in need will take precedence over any owner surrendered dog. Due to the lack of foster home, in most cases, you will be required to “foster” your dog until a home can be found.

This information MUST be submitted along with a photograph before we will consider accepting your dog in to our program. Upon completing the below information, IMMEDIATELY email a picture of your dog to our INTAKE COORDINATOR.

No further action is required.  As a 100% volunteer organization, we will contact you as soon as possible, usually within 48 hours. However, depending on the volume of applications we receive, it may take longer for us to respond to you. We appreciate your patience and understanding. In addition to our organization, we encourage you to seek other avenues to rehome your dog.

Please apply to by filling out the form below

Areas marked with * are required.

How did you hear about us? *

If "Other" please specify

Your Name *

Address: Street *

Address: City *

Address: State *

Address: ZIP Code *

Preferred method of contact *
 Phone Email

Primary Phone Number (please include area code) *

Primary Phone Type *
 Home Cell Work

Secondary Phone Number (please include area code)

Secondary Phone Type
 Home Cell Work

Alternative Phone Number (please include area code)

Alternative Phone Type
 Home Cell Work

Best time to call *
 Anytime Morning Afternoon Evening

Email address

Dog name *

AKC name

AKC number

Dog birthdate

How did you get the dog originally?*

When did you get the dog originally?

If from a breeder, have you contacted them?*
 Yes No Not applicable

Why do you need to re-home your German Shepherd*

When does the dog need to leave your home?*

Are you willing to foster the dog after legally relinquishing the dog to us until a permanent home can be found?*
 Yes No

Dog Gender*
 Male Female

Dog color*

Dog weight*

Dog tattoo

Dog micro-chip (make & number)

Dog identifying marks (scars, broken teeth, etc)*

Dog general overall appearance*

Dog likes
 Dogs Cats Other Small Animals Children Strangers Visit to Vet Crate Car Rides Toys and Play Water Being Groomed Traveling Running/Jogging Like Walks

Dog dislikes or habits
 Dog Aggression Food Aggression Toy Aggression Fence Jumping Escapes Yard Digging Separation Anxiety Chewing Barking when left unattended Destructive Scared of Thunder Storms

Dog other fears or dislikes

Dog other aggressions

Dog temperament towards people
 Friendly Shy Cautious Outgoing Hyper Energetic Calm Anxious Dominant Submissive Submissive Peeing Obedient Challenging

Dog temperament towards other dogs
 Friendly Shy Cautious Outgoing Hyper Energetic Calm Anxious Dominant Submissive Obedient Challenging

Has the dog ever bitten a human? *
 Yes No

If yes, describe

Has the dog ever nipped/shown aggression towards a human? *
 Yes No

If yes, describe

Has the dog ever had formal training? *
 Yes No

If yes, describe

Has the dog been crate trained? *
 Yes No

Describe any behavior

What is the dogs energy level? *
 Very Low Low Average High Very High

Dog history
 House Dog House Broken Outdoor Dog Tied Up Contained in Open Yard Sleeps Inside Sleeps in Garage Abused Neglected in any way Hit by a car Bred Allowed on the furniture Allowed Off the leash in NON fenced area Attacked by another animal Kenneled Used to wearing a collar

How does this dog signal to go outside

What words or commands does this dog know

Veterinarian name

Veterinarian phone

Veterinarian address

Veterinarian - date of last visit

Date of DHPP

Date of Rabies

Date of Bordetella

Date of Heart Worm

Heart Worm results
 Unknown Positive Negative

Preventative brand

Is the dog spayed/neutured? *
 Yes No Don't know

Dog Allergies?

Dog Medical Problems?

Dog medications required?

Describe any past surgeries

Describe any past emergency care

Describe current dog food *

Describe feeding schedule and quantity *

Items you are sending with the dog
 Toys Crate/Bed Food Collar with Tags Leash Medication Other

If "Other" please specify

Is there anything else we should know about the dog?

Human check (required)