Create Account or Log In:
Creating an account or logging in via facebook/email will let you save your application, and allow you to access your pets medical records and other important information after you adopt or foster.
Please be honest and candid to help us determine if we have a foster available for your dog.
Age & Birthdate
Has your dog been microchipped or tattooed?
Please provide a copy of all medical records, including the current rabies certificate and the spay/neuter certificate (if applicable).
Does the dog have an up to date Rabies Vaccine?
Does the dog have up to date Bordetella
Does the dog have an up to date Distemper(DHPP) vaccine?
Date of last Fecal Test
Date of last heartworm test:
Is your dog currently on Heartworm Preventative Medicine?
If yes, when was the last Heartworm Preventative Medicine Given?
Is your dog currently on Flea/Tick Preventative Medicine?
If yes, when was the last Flea/Tick Preventative Medicine Given?
Date of last deworming:
Has your dog ever been checked for hip dysplasia?
Has your dog ever been x-rayed?
For what purpose?
Has your dog ever been used for breeding
Does your dog have any medical conditions or take any medications? (Please include medication and dose)
Previous veterinarian's name, address and telephone number:
Please attach any medical records here:
All dogs, especially puppies and young adults, have behavior issues. Our trainers and foster homes need to know what types of issues you are having with your dog so they can successfully work with the new owners. Thank you!
Why are you giving up your dog?
Describe your dogs personality:
Is your dog housebroken?
What is your dog's signal they want to go outside?
Does your dog ever have accidents?
Has your dog been raised around children?
Please describe your dogs behavior around children:
Does your dog show a preference to men or women?
How does your dog react around strangers?
Has your dog been exposed to other dogs? If yes, describe their behavior:
Has your dog been exposed to cats? If yes, describe their behavior:
How does your dog react to meeting new dogs?
Does your dog show any protectiveness or resource guarding towards its food, toys or people?
If yes explain:
Does your dog ride well in the car?
Does your dog walk well on a leash?
Does your dog door dash when they see the door open?
Has your dog received any obedience training? If yes please describe methods used:
Does your dog chew things other than toys:
Does your dog dig?
Does your dog jump on people?
Does your dog steal things off the counter or table?
Does your dog jump fences?
Does your dog have any other habits good or bad you would like to share?
Does your dog have any silly personality quirks the rescue should know about?
Is your dog crate trained:
Where does the dog sleep?
What type of toys and games does the dog enjoy?
Is there anything the dog dislikes? (Sudden movements, their tail touched, etc.)
What is the dogs feeding routine and what food are they on?
What are your dogs preferred treats?
Please describe the ideal home you would like to see for your dog based on their personality?
Does the dog have ANY history of aggressive behavior (biting, growling, baring its teeth, etc.) towards another animal or human?
If yes, please provide a detailed description of EACH incident, including (1) the severity of the incident; (2) whether the aggression was directed towards a human (please indicate age) or another animal (please indicate type and size); (3) any actions taken by others that provoked or caused the aggressive behavior; and (4) any corrective action taken or legal sanctions imposed as a result.
I undersdand that this form is for information purposes only, to help assess if GHGDR has placement for the animal I hope to surrender.
I understand that the animal will not be considered surrendered until I have signed the surrender contract and turned the animal over to a GHGDR representative.
I agree to the Statement of Understanding Above
By typing your name below you agree to the "Statement of Understanding Above"
What does your surrender time line look like?
If other please explain:
Please give any other specifics of your situation here: