Agency Release Form

Date*

Dog's name*

Sex*

Age

Date of Birth

Spayed/Neutred

Weight

AkC or VDD Registration #

if applicable

Dog's description*

The agent named below has the authority to release said dog to the National GWP Rescue, Inc a federally recognized non-profit charity sponsored by the German Wirehaired Pointer Club of America. NGWPR specifically cares for purebred German Wirehaired Pointers.

It understand that the below listed agency is permanently releasing this dog to National GWP Rescue, Inc. (NGWPR) for fostering and placement into a suitable permanent home;

1. It is understand that the agency below is releasing all claims to this dog as of the date entered on this form;

2. As an agent of the agency below, I will inform NGWPR of all known material facts that apply to this dog, inluding but not limited to any health issue or bite history.

3. Additionally, the below name agency may not attempt to reclaim said animal either from NGWPR or from the new adoptive owner after I have released said dog for adoption:

As evidenced by my completion of this form as an agent of below listed agency, I agree to the above terms:*

YesNo

Agency/Shelter/Rescue Name*

E-mail*

Agency Phone Number*

Area CodePhone Number

Best Time To Call*

Agency Address*

City*

State*

Zip*

Agent Name*

First NameLast Name

Please tell us about your dog

Reason for Release

StrayOwner Surrender

Personality/Temperment*

(friendly, shy, cuddler, etc)

Dog is allowed*

IndoorsOutdoorsGarageOther

Please explain OTHER

Dog Sleeps*

IndoorsOutdoorsGarageOther

Please explain OTHER

What Brand do you feed your dog?

Type: Wet/Dry

How Much

How many times a day

Housebroken*

Energy Level*

Has Your dog every bitten anyone?*

If YES, please explain

Good with cats?*

Good with other dogs?*

Good with children under 18?*

Is your dog current on all shots & vaccinations?*

Please list all shots & vaccinations

Is the dog microchipped*

Do you have all the info*

Date of last Vetrinary Exam

Name of Vet

Phone Number

Please list any medications the dog needs

Any other information you feel pertinent

Please attach photos of your dog - A head shot and full body shot are preferred. *If your unable to resize your photos, please email photos to ngwprescue@gmail.com

Upload a File

Agency/Shelter/Rescue RELEASE FORM