Surrender Form First and Last Name (required) Your Email (required) Your Address (required) City (required) State (required) Zip Code (required) Home Phone (required) Cell Phone Surrender Information Name of Dog (required) Breed of Dog (required) Color (required) Weight (required) Where did you get the dog from? (required) Breeder name and State if available? Why are you surrendering the dog? (required) Veterinarian Information Clinic Name (required) Clinic Phone Number (required) Date of the last vet visit? Does this dog have any known health issues, past or current? Date of last Rabies vaccine? Date of last DHLPP? Date of last Bordetella vaccine? Date of last Lyme's vaccine? Date of last Heartworm Preventative? Type of prevention given? Date of last flea and tick preventative? Is this dog Spayed or Neutered? YesNo Does the dog live with children, or been around children? YesNoNot Sure If yes, how does the dog behave with children? Has the dog ever shown aggression towards? (select all that apply) (required) MenWomenChildren (under 12)Children (over 12)Other AnimalsNone of the above Does the dog get along with: (select all that apply) (required) CatsFemale DogsMale DogsPuppies Please list any fears the dog has and how the dog reacts (required) Is the dog housebroken? (required) YesNo How does the dog let you know if has to go potty? (required) Please list commands the dog knows and responds too (required) Is the dog crate trained? (required) YesNo Is the dog allowed to roam free at night or when no one is home? (required) YesNo Does the dog do any of the following? (select all that apply) (required) Chase CarsClimb FencesChew Inappropriate ItemsDigCounter SurfGet into GarbageNone of the above Surrender for adoption or sanctuary: By submitting this surrender form, I am relinquishing all rights to the Great Dane listed above. I am the sole legal owner of this dog. I agree to release or have my veterinarian release all medical information relating to this dog. I understand OZR Great Dane Rescue, Inc. is a non-profit, volunteer organization, and they will make every effort to place the dog in a proper environment. I further understand that I will be allowed no further contact with the dog once it is physically relinquished to OZR Great Dane Rescue, Inc. A surrender fee is not required but is greatly appreciated to help with the care of the dogs. If you have toys, blankets, crates, or any other items of the dogs and would like to donate them to the rescue it would be greatly appreciated. Age of Dog? (required) Signature (required)
