National Rescue/PA
Surrender Questionaire


Deborah Orpen
PA State Coordinator, GSP Rescue PA
47 South 14th Street
Pittsburgh, PA 15203
Tel: 412 - 381-9959

Dog's Registered Name

Call Name

Breed

 German Shorthaired Pointer

Birth Date

AKC papers?

AKC#

Tatto or microchip number

name of microchip registry and contact info

Color / Markings

Housetrained

Crate trained

Physical problems, allergies

Veterinarian name

Veterinarian address

Veterinarian phone#



Date of most recent inoculations:

DHLPP

Corona

Bordatella

Rabies

Heartworm test

   Date last administered  



What is your dog's reaction to:

*Other Dogs?

*Children?

*Strangers?

*Cats?

*Being alone in a fenced yard?

*Being alone in the house?

*Being alone in the car?



What does your dog...

*Like best?

Dislike?

Fear?



How does your dog react when fearful, unhappy? Please, explain:



How does your dog spend it's day? Where does it sleep?

Has your dog ever bitten a person?

Has your dog ever bitten another dog?

If so, please describe the incident?

What dogfood brand?

Amount and time, you have been feeding your dog?

Has your dog had any training?

Trainer name

Phone

Type of training

List commands, tricks, skills your dog knows and is familiar with
(including house & crate training):

Dog's bad habits

Why are you giving up your dog?

Describe the ideal home for your dog?

Where did you get your dog?

How old was your dog, when it first came to you?

Name of Breeder

Breeder's Address

Breeder's Phone#

Name, Address, Ph# of prev. owner:


Any other comments about your dog; anything that may help us in finding the proper home:
 

I, the undersigned, , do hereby surrender to the German Shorthaired Pointer Club of America, Inc. National Rescue program this German Shorthaired Pointer, named: . I certify that I am the owner of this dog, free and clear of all other interests. i also certify that this dog is not possessed of any dangerous or vicious propensities. The information I have provided about the history of this dog is true and complete to the best of my knowledge.

I authorize German Shorthaired Pointer Club of America, Inc. National Rescue to place this dog into a new home at their discretion and the best of their ability. I irrevocably relinquish unto German Shorthaired Pointer Club of America, Inc. National Rescue all rights title, and interest in and to the dog surrendered.

I hereby forever release, discharge, and agree to hold harmless and indemnity the German Shorthaired Pointer Club of America, Inc. National Rescue program, its board of directors, its officers, members, and agents from all claims, demands, actions, causes of action, and liability of any kind whatsoever arising as a result of or in connection with the surrender and subsequent adoption oor other disposition of this surrendered dog.

I have read the above, I understand and agree to it,

Date:

Signature (type full name)

Address:

City, State, Zip:

Home Phone

Email