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 NOTE THAT ALL QUESTIONS REQUIRE AN ANSWER, EVEN IF THERE ISN'T ONE. IF NOTHING TO ANSWER PLEASE WRITE NA OR NONE TO MOVE ON.
Dog's Name
What is the gender of your dog?
Has your dog been altered (spayed/neutered)?
Has your dog's stomach been tacked?
If yes, was this done as a preventative or after bloat?
Is the dog purebred?
Dog's current weight:
Dog's date of birth:
Dog's current age:
Dog's color:
Reason for surrender (please be specific):
How long have you owned this dog?
Where did you acquire this dog?
What can you tell us about your dog's past prior to your ownership?
If shelter/rescue or breeder, please provide a name and phone number:
If breeder, did you sign a contract?
If breeder, have you contacted them about surrendering?
If breeder, who did you speak to and on what date?
If breeder, why can't they take back your dog?
If your dog is registered, please provide the registry (AKC, UKC, CKC) and registration number:
Is your dog microchipped?
If yes, please provide the number and where it is registered.:
Name of veterinarian:
Phone number of veterinarian:
When did your dog last see a veterinarian?
Is your dog afraid at the vet?
If so, how does s/he display fear?
Does your dog need to be muzzled or sedated at the vet?
Has your dog ever bitten or attempted to bite veterinary personnel?
Does the Dane have any health problems, old or current injuries or concerns?
If yes, please list all:
Has your dog ever required surgery?
If so, please explain:
Does your dog have skin issues, allergies, or hot spots?
If yes, please explain:
Does your dog get ear infections?
Is your dog current on vaccinations?
Has your dog been tested for heartworm?
Heartworm preventative brand:
Last dose date:
Flea/tick preventative brand:
Is your dog on any medications or a special diet?
Food brand:
Food type:
Times your dog eats:
Does your dog prefer men or women or get along well with both?
Is your dog good with children - toddlers to age 7?
Is your dog good with children 8 and older?
If your dog dislikes men, women or children, please explain the behavior in detail:
List the age and gender for each person the dog has lived with:
Has your dog ever made contact with or bitten a person; attempted to bite or snap at a person; or acted in a way that someone may have thought they were attempting to bite?
If yes, please explain the situation leading up to the event(s), the relationship between your dog and the person and the severity. Was the bite provoked? Was medical attention necessary for the person and do you have photos of the bite?
Have you ever been fearful of your dog?
If yes, please explain the circumstances:
Can you easily take toys, food, rawhides, or bones out of your dog's mouth?
Does your dog guard its food or toys from other dogs/people?
List the type, ages and sex of other ANIMALS the Dane has lived with:
Does your dog get along with male dogs?
Please explain how your dog behaves or reacts when around male dogs:
Does your dog get along with other female dogs?
Please explain how your dog behaves or reacts when around female dogs:
Has your dog ever shown reactivity toward another animal? (some signs of reactivity include fear, anxiety, growling, snarling, lip curling, biting)?
What is your dog's overall temperament and history of interacting with other animals:
If there has been an incident(s), please explain in detail and if your dog instigated the negative behavior. What was the outcome? Did either dog require medical treatment? If so, do you have photos?
Is your dog housetrained?
How does the dog tell you they need to go outside?
Does your dog have accidents in the house?
Has your dog had formal obedience training?
If yes, please describe:
Does your dog walk nicely or pull on the leash?
When leashed, how does your dog behave? Does your dog lunge at other dogs or people?
If yes, please describe your dog's actions and what you have done to prevent/correct this behavior:
What kind of collar or harness do you use when walking your dog?
How does your dog react when you try to lead them by the collar?
When does your dog bark?
Is your dog's barking excessive?
Where does your dog sleep?
When your dog is left alone, is it destructive?
Is your dog used to being crated?
Is your dog used to free roam?
Does your dog chew inappropriate items?
Select all that apply to your dog:
What are his/her favorite toys/games/activities?
What kind and how much exercise does your dog need?
What outdoor situation(s) is your dog used to?
If you have a fence, how high is it?
When your dog is being naughty, what is s/he doing?
How does your dog behave when (s)he is scared?
Has your dog been around cats?
Describe your dog's behavior when entering and exiting your vehicle:
Tell us something you love about your dog:
Giving veterinary care to your Dane will cost the rescue an average of $250-$750. Would you like to donate to help cover the cost of care?
Is there anything else we should know that will help us place the dog in a suitable home?
Describe how your dog behaves when riding in a vehicle:
I certify that I am the legal owner of the dog described above. I warrant and represent that this dog has either never shown signs of aggression towards human beings nor bitten a person or if a history of biting humans or animals and/or known aggression exists it has been noted above and fully disclosed to UMGDR. I hereby voluntarily relinquish all claims and ownership of said dog to the organization known as Upper Midwest Great Dane Rescue. ("UMGDR"). I am irrevocably transferring and relinquishing to UMGDR legal ownership of, and microchip registration/reregistration rights to this dog on the date hereof. I further acknowledge understanding that the dog becomes the property of UMGDR, and that UMGDR will spay/neuter this dog if intact, and will make every effort to place this dog in a new family setting. However, if the dog has serious health issues, serious behavior issues or aggressive issues, UMGDR has the right to euthanize the dog at its discretion.
I understand UMGDR reserves the right to withdraw from accepting surrender of my dog if the surrender form has been found to be materially false including but not limited to registration, vaccinations, and/or the aggressive behavior of the dog. Withdrawing from accepting surrender by UMGDR should be done in a reasonable time near the time the dog is surrendered.
By signing this form, I hereby certify that I have honestly answered all of the above questions, to the best of my knowledge, and have read and completely understand the above release.:
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.