Surrender

Page 1 of 9

Surrender

Current Owner

Date*
Invalid Input

Owner’s Name*
Invalid Input

Address*
Invalid Input

City*
Invalid Input

State*
Invalid Input

Zip*
Invalid Input

Home Phone*
Invalid Input

Work Phone
Invalid Input

Cell Phone
Invalid Input

Email
Invalid Input

 

Dog Information

Dog’s Name*
Invalid Input

Sex*
Invalid Input

Age*
Invalid Input

Color*
Invalid Input

Ears*
Invalid Input

Tail*
Invalid Input

Spayed/Neutered?*
Invalid Input

Does the dog have any markings?
Invalid Input

Length of ownership*
Invalid Input

Where was the Doberman acquired? *
Invalid Input

What type of food does the dog eat?*
Invalid Input

How often is the dog fed?*
Invalid Input

Provide a picture of the dog:*
Invalid Input

Additional picture of dog
Invalid Input

 

Medical History

Date of last visit to the vet:*
Invalid Input

Is the dog currently on heartworm prevention?*
Invalid Input

What Heartworm Prevention Brand do you use?*
Invalid Input

Which day of the month do you give the heartworm prevention?*
Invalid Input

Results of Last Heartworm Test:*
Invalid Input

Date of last Rabies Vaccination*
Invalid Input

Date of last DHLPP Vaccine*
Invalid Input

Date of last Bordetella Vaccination*
Invalid Input

List any health problems, special needs, or injuries
Invalid Input

Please list any medications and dosages and frequency this dog takes regularly:
Invalid Input

 

Veterinarian Information

Vet's Name*
Invalid Input

Vet's Address*
Invalid Input

Vet's City*
Invalid Input

Vet's State*
Invalid Input

Vet's Zip*
Enter a number

Vet's Email
Invalid Input

Vet's Phone*
Please use the format xxx-xxx-xxxx

Vet's Fax
Please use the format xxx-xxx-xxxx

 

Dog's Behavior

Has the dog ever bitten, snapped, or growled at anyone?*
Invalid Input

If Yes, please explain:
Invalid Input

This Doberman is (check all that apply)*
Invalid Input

If other
Invalid Input

This Doberman will chase (check all that apply)*
Invalid Input

If other
Invalid Input

Does this dog get along with of the following (check all that apply)*
Invalid Input

If other
Invalid Input

Would you recommend this dog be placed with small children?*
Invalid Input

If no or unsure, please explain:
Invalid Input

Explain any obedience training the dog has had:*
Invalid Input

 

Surrender Information

What is the reason for surrender? *
Invalid Input

Length of time dog can remain in your care until foster space becomes available or dog is placed in permanent home*
Invalid Input

 

Additional Information

Please provide any other information to help us place this dog in an appropriate home:
Invalid Input

 

Donation Amount

Donation Amount*
Invalid Input

Taking the dog into the HADR program will not only take up valuable foster space that may compromise our ability to save dogs in kill shelters, it will also cost us for basic care and any additional vetting that may be required. How much can you donate to help find your dog a new home?

 

Signature

I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. I HEREBY RENOUNCE ANY AND ALL CLAIM TO THE DESCRIBED DOG. I FULLY UNDERSTAND THAT I WILL NOT EVER KNOW THE WHEREABOUTS OF THE DOG. WITH THIS INSTRUMENT THE DOG BECOMES THE PROPERTY OF HOUSTON AREA DOBERMAN RESCUE. I AM IN FULL AGREEMENT WITH THESE TERMS OF SURRENDER.

Type your name (virtual signature)*
Invalid Input

Date*
Invalid Input

Invalid Input