GRATEFUL GOLDENS RESCUE of theLOW COUNTRY

OWNER RELEASE

AGREEMENT

THERE ARE MANY COSTS ASSOCIATED WITH FINDING A GOOD HOME FOR YOUR DOG.

TO HELP ASSIST WITH THESE COSTS WE ASK THAT YOU BRING YOUR DOG UP TO DATE ON SHOTS AND/OR SPAY/NEUTER THEM.

Please attach a copy of all veterinary and shot records along w/ most current rabies certificate to this form.

Please attach a copy of AKC and/or pedigree papers to intake form

Please answer each of the following questions as completely and honestly as possible:

Dog’s Name: ______Age: ______Sex: ______

Owner’s Name: ______

Address: ______

City/State: ______

Phone: Home: ______Cell: ______

  1. What is the reason for giving up this dog? ______

______

  1. Name, address & phone of veterinarian(s) ______

______May we contact for verification of treatment ______

  1. Date of last vaccinations? ______(DHLPP) ______(rabies) ______Bordetalla
  1. Date of last heartworm test? ______Has the dog received heartworm preventative? Y / N Date:______Brand: ______
  1. Is the dog spayed/neutered? Y / N If yes, when? ______Where? ______
  1. Date of last fecal check for worms? ______Result? ______
  1. What medical conditions does this dog have that a new owner should know about? ______
  1. Does the dog have any skin problems, allergies or hot spots?______
  1. Has this dog had any surgeries? ______
  1. Has this dog ever been treated for being heartworm positive?(explain) ______
  1. Is the dog housebroken? Always_____ Almost Always______Partly _____ Paper Trained ______No ______
  1. Does it “ask” to go outside? Y / N If yes, how? ______
  1. Where does the dog stay when home alone? ______
  1. Does the dog like to: Ride in a car? ______Swim? ______Run away? ______Favorite toy? ______
  1. Does dog: Jump fences? _____ Dig? ______Chew? ______Bark? ______Outside?______Inside? ______

Jump on people? ______Submissive wetting? ______Guards food?______guards toys? ______

  1. Can you take food or toys away from this dog? ______How often is the dog groomed? ______Professionally groomed or by yourself? ______If professionally where? ______
  1. Is the dog on flea preventative? Y / N If yes what brand?______
  1. Has the dog been to obedience class or a trainer? Y / N If yes, when? ______where? ______

what kind of class? Group / individual

  1. What commands does it know? Sit ___ down _____ off____ stay____ come ______other______
  1. Does the dog accept strangers? ______Does the dog accept other dogs? ______
  1. Does the dog like children? ______How many children are in your home? ______Ages? ______
  1. How does the dog react to other dogs?:______
  1. How does the dog react to cats? ______
  1. Can you grab the dog by the collar? ______Can you touch him anywhere? ______
  1. Does the dog like to grab your arm or clothes?______
  1. Has the dog ever growled at you? ______Has the dog ever growled at anyone else or another dog? ______
  1. How often is the dog fed? 1 x______2x______free fed______Amount? ______
  1. What brand of dog food do you use?______
  1. Is the dog possessive of food or food dish? ______Does he steal food? ______Jump on counters? ______
  1. Is the dog used to: Being walked? ______If yes how often?______Tied out? ______Crated? ______

Running loose? ______Where does the dog sleep? ______

  1. What correction methods have you tried? Corrective collar(describe) ______Confined to garage_____ Yard______

Basement_____ Crate_____ Room______Rolled up newspaper____ Holler no/stop____ Smack w/ hand_____

Bad dog _____ Other______

  1. How long have you had the dog? ______Age of dog when acquired______

Where did you acquire from______

Did you have a verbal or signed agreement with the breeder or previous owner? ______

  1. Has your dog ever been used for breeding? YES or NO

If yes, how many litters has she had ______date of last litter ______

If yes, how many times has your dog been used as a stud ______date of last stud ______

  1. Please list any other info that may be helpful to new owners:______

______

______

______

______

Please retain copy of document for your records.

Return original to GGRLC volunteer or mail to: GGRLC P O Box 2519, Mt. Pleasant, SC 29465-2519

release of ownership4 ver 01/11