Surrender Request Form

Name*

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Animal's Name

Breed*

Specie*

Age/Date of Birth*

Gender*

Is your animal fixed (spayed/neutered)?*

YesNoI’m not sure

Is this dog current on vaccinations?*

YesNoI am not certain

How long have you owned this animal?

How is your animal with people?

Has your animal ever bitten a person? Please explain

Why are you surrendering your animal?

Does the animal have any medical conditions/medications/allergies, etc? Describe

Does the dog have any livestock guardian dog experience? Include type of animals it has guarded

Any behavioral issues as an LGD?

Any animals they don’t do well with?

Has she/he ever guarded birds? If so, anyissues, or any unalivings?

How are they with cats? Any issues?

Current Veterinarian and/or medical clinic name, address, phone, email and website

Has the animal ever been abused or neglected? Describe

Is there anything else you want to tell us about your dog?

Does the animal have any aggression issues?

Does the animal escape or wonder off the property? Do they go over or under? What type of fencing do you currently have? How tall is your fence?

Is he/she good with children?

What training does the animal have?

How is your animal with other dogs?

Is the animal housebroken?

Is the animal kennel trained?

What is your animals current sleeping arrangements?

What things would you want a new owner to know about your dog?

What is the animals current food, how much and when does he/she eat?*

By signing below I agree to the following statements:

I/We are surrendering this animal to Golden State Great Pyrenees Rescue & Sanctuary at no cost to Golden State Great Pyrenees Rescue & Sanctuary.

I understand there may be a cost associated with surrendering my animal to the Golden State Great Pyrenees Rescue & Sanctuary.

Please upload a photo or photos of your dog.*

Print Name*

Signature*

Date:*

MonthDayYear