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Personal Information

* First name

* Last name

* Email

* Email confirmation

Home phone

Cell number

* Current Address

Current Address 2

* Zip

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*State/Province

Owner Surrender Form

We understand that giving up your dog is a difficult decision, but we realize that in making this choice, you are thinking about your dog's best interests. We are here to help. Above all, please be honest; we understand your dog may not be perfect, but the more we know, the better we are able to find the right new home for your dog. Your dog deserves a second chance to find a wonderful home, and by providing us with the detailed information, you will help us to better accomplish this goal. Every dog is placed in an approved foster home until an appropriate permanent home is found. In all cases the best interests of the dog is paramount. We applaud your decision for giving your dog a second chance for a good life through this program.

One of our volunteers will be reaching out to you upon receipt of this form to address any lingering questions and discuss next steps.

Have you been in contact with any of our volunteers yet to coordinate surrender? If so, please provide the name of the person you have been working with. (This is NOT a requirement, but will help us know if there is someone already working with you to find a new home for your dog).

What is your dog's name?

What is your dog's gender?

Male - NeuteredMale - Not NeuteredFemale - SpayedFemale - Not Spayed

How old is your dog?

What is your dog's date of birth?

If not known, please provide an approximate date to the best of your knowledge.

Description of Dog (Color, markings)

How much does your dog weigh?

What kind of dog is it?

Please answer to the best of your knowledge

Purebred NewfoundlandNewfoundland MixOther

If your dog is a Newfoundland Mix, or Other, please provide details on what breed(s) you believe your dog is mixed with

How long have you had your dog?

Where did you get your dog?

BreederAnimal ShelterAnimal RescuePet StoreOther

Please provide details on where you got your dog.

i.e. Name of the breeder, rescue or pet store, or if other, please explain.

Is your dog microchipped?

If yes, please provide the chip number if known. If you don't know the chip number we will scan your dog at intake.

Please provide the name, address and phone number for your current veterinarian.

We'll be reaching out to your vet to get copies of any medical history for your dog. Please contact your vet and let them know that one of our volunteers will be reaching out to request this information. **Note, this is not used in determining if we will take your dog, simply so that we don't repeat vetting such as vaccines or spaying if they've already been done.

Does your dog have any medical issues we need to know about?

Please provide details on any known medical issues so we can promptly have them addressed by our vet. This many include things like a prescription diet, frequent ear infections, hot spots, injuries, etc. **Note, this is not used in determining if we will take your dog, simply so that we can prioritize addressing these items as quickly as possible.

Veterinary Records Release

As a part of our intake process, National Newfoundland Rescue (NNR) requires all medical records for the dog being surrendered to NNR.

I certify that I grant my veterinarian(s) permission to release all records pertaining to the dog I am surrendering to NNR, giving NNR all rights and permission to gather and retain veterinarian records for the above listed dog.

I authorize NNR to contact my veterinarian(s) directly to obtain all records of the dog being surrendered. I do NOT authorize NNR to contact my veterinarian(s) to obtain records, and I understand that by not having these records, it may negatively affect NNR’s ability to commit to taking the above named dog into rescue.

Does your dog like to ride in cars?

YesNo

Is your dog crate trained?

YesNo

Is your dog house broken?

YesNo

Does your dog like to play with toys?

YesNo

Is your dog good with other dogs?

YesNo

Is your dog good with cats?

YesNoUnknown

Does your dog chase cars?

YesNo

Is your dog good with strangers?

YesNo

Is your dog good with children?

YesNo

Does your dog come when called?

YesNo

Is your dog leash trained?

YesNo

Does your dog jump fences?

YesNo

Has your dog shown any signs of aggression towards people or other animals. If yes, please explain in detail.

Has your dog ever bitten a person?

YesNo

If yes, please provide details of the situation

Where is your dog used to being during the day?

Where does your dog sleep at night?

What commands does your dog know?

What does the dog like/dislike?

What are the dogs best/worst points?

Why are you surrendering your dog?

Please provide current pictures of your dog for identification.

Please include a full length picture. The application will only allow for one photo to be attached. If you would like to send additional photos, they can be emailed to intake@nationalnewfoundlandrescue.com.

Ownership Certification and Release. By selecting Yes and submitting this form, you agree to the below statements and recognize this form as a legal signature for the surrender of the above mentioned animal to National Newfoundland Rescue Inc.

Ownership release will not go into effect until National Newfoundland Rescue Inc. reviews this form to confirm that the dog referenced is eligible to come into the rescue program, and agrees on a day / time to take possession of the dog.

National Newfoundland Rescue Inc. reserves the right to decline a dog from coming into rescue for any reason. If the dog is declined to come into rescue, the owner surrender form is immediately voided.

I/We certify that I/we own the above dog, free and clear and that the statements above are true and accurate. I/We agree to indemnify and hold harmless the National Newfoundland Rescue Inc. by, from and against all claims, suits, damages, liabilities and costs related to or in any manner connected with this dog. I/We further acknowledge understanding that the dog becomes the property of National Newfoundland Rescue Inc.

YesNo

What is your dogs feeding schedule?

Please provide details on the brand of food currently given, the number of times a day your dog eats and how much he/she eats per meal.

I have read and agree to the terms and conditions. By checking this box I am confirming that I am 13 years of age or older.

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