Owner Surrender Agreement

Date

Animal Name

Species

Age

Breed

Sex

Spayed/Neutered

Has your pet bit or scratched a person in the last ten (10) days?

Why are you surrendering your pet? Please provide as much info as you can; it helps us better care for your pet.

If we could help you resolve issues with your pet, would you be interested in keeping the animal?

If yes, what would you need?

How long have you owned the animal?

How many homes has the animal had?

Where did you get the animal?

Does your animal have:

Has your animal been to a veterinarian?

Are they current on vaccinations?

Has your pet been hit by a car, injured, or required other surgery?

Has your pet been diagnosed with and/or treated for any of the following:
(Check all that apply)

How would you describe your animal most of the time? (check all that apply)

Loves kids:

Good with men?

Good with women?

Good with cats?

Good with dogs?

What is the animal's favorite toy?

What brand of food has he been eating?

Food type:

Where do they like to sleep?

What, if anything, are they afraid of?

What, if anything, has your animal been aggressive towards?

How is your dog with livestock & farm animals?

Has your dog had any obedience training?

If they have had training, what kind of training was it? (check all that apply)

Is your dog crate trained?

What commands does your dog know? (check all that apply)

Does your dog come when called?

Has your dog been used for hunting?

Does your dog jump fences?

Does your dog dig under fences?

Is your dog house trained?

How does your dog let you know when they have to go to the bathroom?

Where is your dog kept during the day?

Where is your dog kept at night?

Has your dog ever bitten a person?

Is there anything else a future owner should know about your pet?

 I certify that I am the owner of or have the authority to surrender the animal described to GDU. I hereby relinquish all rights of ownership and any right to information on the disposition of the animal described to GDU. I also authorize the release of any veterinary records regarding the animal. I certify that to the best of my knowledge I have disclosed all of the information about the animal concerning health, behavior, history and anything else that may affect the safe placement of the animal in a new home.

By typing my name below, which I hereby adopt as my electronic signature, I affirmatively consent and agree that:

1. We can electronically provide to you all documents, agreements and disclosures.

2. electronic signature on agreements and disclosures has the same effect as if I signed them in ink.

LEGALLY BINDING SIGNATURE (TYPE YOUR FULL NAME)

PLEASE INDICATE THE DATE