Rescue or Shelter Transfer

Rescue or Shelter Transfer

Rocky Mountain Great Dane Rescue, Inc.
Thank you for reaching out to Rocky Mountain Great Dane Rescue, Inc. in regards to a dog in your care. We understand that sometimes dogs come into your care with minimal information, so please fill out this form as fully as possible in order to allow us to determine if we have the resources for this dog. Any additional pictures, medical/behavioral records, or other files pertintent to this dog can be sent to shelterrequests@rmgreatdane.org.
Name of Your Rescue or Shelter
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Rescue or Shelter Representative
Representative's Email
example@example.com
Representative's Phone Number
Additional Phone Number
Dog's Name/Nicknames
Please only include ONE dog per form
Dog's DOB/Approximate Age
Is there a date that the dog needs to be rescued by, i.e. euthanasia date?
Is the dog a purebred Great Dane or a Great Dane Mix?

Dog is purebred Great DaneDog is a Great Dane Mix
If the dog is a mix, what breed is it mixed with?
Dog's Color and Markings
Dog's Current Weight
Gender

MaleFemaleI am not sure
Is the dog spayed or neutered?

YesNoI am not sure
Is the dog microchipped?

YesNoI am not sure
If microchipped, please provide microchip number here:
Ears

NaturalCroppedI am not sure
Please upload a current picture of this dog (1 of 3). If the file is too large, you can email the picture to us instead.

Browse Files

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Please upload a current picture of this dog (2 of 3)

Browse Files

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Please upload a current picture of this dog (3 of 3)

Browse Files

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Please explain how this dog came into your care, i.e. why the previous owner surrendered the dog.
How long has the dog been in your care?
Has the dog been medically evaluated by a veterinarian within the last year?

YesNoI am not sure
Veterinarian's Name
Veterinarian's Address
Veterinarian's Phone Number
Has this dog ever required any surgeries?

YesNoI am not sure
If yes, please explain the require surgery/surgeries.
Is this dog up to date on vaccinations?

YesNoI am not sure
Has this dog been tested for heart worm in the last year?

YesNoI am not sure
Has this dog ever been diagnosed with, or treated for any of the following, check all that apply:

AllergiesBloat/GDVWobbler's SyndromeOrgan FailureThyroid DiseaseEpilepsy/SeizuresDCMHip DysplasiaElbow DysplasiaHeartwormNoneOther
Does the dog need any medications or special diet?

YesNo
Is the dog housebroken?

YesNoI am not sure.
If the dog is NOT housebroken, how often do they have accidents?

Once a dayOnce a weekEvery time the dog is inside
If the dog is NOT housebroken, please explain. Has the dog ever been seen by a veterinarian for this problem?
Has this dog been behaviorally evaluated? If so, when was the evaluation and please explain the behavior evaluation and outcomes.
Does the dog exhibit any resource guarding or food aggression?
Does the dog exhibit any form of aggression or reactivity, such as leash aggression/reactivity, kennel aggression, dog aggression/reactivity, human aggression/reactivity, etc?
How would you explain the dog most of the time? Check all that apply.

Very activeCouch potatoTalkativeQuietPlayfulFriendly to familyShy to familyFriendly to visitorsShy to visitorsAffectionateLap dogFearfulIndependentFearlessAloofWithdrawnOther
How does the dog like to play? Check all that apply.

Plays gently, does not use teeth or clawsLikes to play rough, may bite or scratchLikes to play ballLikes stuffed toysLikes to learn tricks for treatsLikes to play in or around waterLikes to play with dogs of all sizesPrefers to play with larger dogsPrefers to play with smaller dogsNot interested in playOther
Is the dog crate trained?

YesNoI am not sure
Is the dog destructive with free roam?

YesNoI am not sure
How does the dog walk on a leash? What sort of collar/leash is being used?
Has the dog ever bitten a human?

YesNo
If the dog has bitten a human, where on the body and what were the circumstances?
Has the dog ever bitten another animal?

YesNo
If the dog has bitten another animal, what kind of animal and what were the circumstances?
Has the dog ever lived with other dogs?

YesNoI am not sure
If yes, please explain how the dog's got along living together, the age, sex, and breed of each dog the Dane has lived with, if known.
Has the dog ever lived with cats?

YesNoI am not sure
If yes, please explain how the dog and cat got along.
Has the dog ever lived with children (under the age of 18)?

YesNoI am not sure
If the dog has lived with children, what were the ages of the children and how was their relationship?
Is the dog afraid of anything?

MenWomenChildrenHatsBalloonsBroomsVacuumsLarge trucksSudden loud soundsWaterFireworksHandsFeetBicyclesOther
Did the dog ever repeatedly escape from a yard?

YesNo
If yes, please explain the type of fencing, if known, and how the dog escaped.
Does the dog have any quirks or anything the previous owners or current caretakers are not fond of?
Is there anything the previous owners or current caretakers truly love(d) about the dog?
If RMGDRI is able to accept this dog, are there any additional resources you may be able to provide for this dog (i.e. transport, food, veterinary care, etc)? Please note, additional resources are not required but always appreciated to help us continue rescuing Great Danes and Great Dane mixes.
I, the rescue/shelter represtative as stated above, hereby surrender the dog described above to Rocky Mountain Great Dane Rescue, Inc. I certify that this dog is not possessed of any dangerous or vicious propensities, and that I have not willfully concealed information about the dog that might indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify the Rocky Mountain Great Dane Rescue, Inc., its Board of Directors, and its members, officers and agents from all claims, demands, actions, causes of action or liability of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of the above named dog.
Do you agree with the above statement?

YesNo
Representative's Signature

Clear
Today's Date
Dog's Name
Should be Empty: