RMGDRI Owner Surrender

Owner Surrender Form
In order to find the most appropriate home for your Dane, please provide as much detail as possible about his/her history, veterinary care, likes and dislikes, and behaviors. By providing this information you are ensuring the easiest transition for your pet, only you know them best. Behavior and medical issues do not necessarily create problems but not disclosing them certainly will. Please be truthful about your dog's situation so we can try to provide the best resources to them. If you are surrendering more than one dog, please fill out a separate form for each one.

Please be aware that there will be an a wait to find a foster and we are unable to take any dog immediately. Depending our our waiting list, it can take several weeks before we can get a Dane into foster care.

We are not a shelter and depend entirely on our foster homes. Fosters require at least a few days to a week or more notice before bringing a Dane into their homes.

If the situation is urgent, reach out to your nearest shelter.
I agree with, and understand, the above statement.

YesNo
If your dog has any medical or behavioral problems, please reach out to us first to discuss the situation with us prior to submitting the form. Please email rehome@rmgreatdane.org with a brief summary of your dog's concerns and a good contact number and our Incoming Director will be in contact with you.
- Owner's Name*
  
  First NameLast Name
- Owner's E-mail*
- Owner's Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Owner's Preferred Contact Number *
- Owner's 2nd Preferred Contact Number, if applicable
- Dog's Name / Nicknames*
- Dog's DOB /Approximate Age*
- Is the dog a Great Dane or Great Dane Mix?*
  
  Dog is Great DaneDog is a Great Dane Mix
- If the dog is a mix, what breed is it mixed with?
- If the dog is a mix: I understand that because we are a breed-specific rescue, there are additional steps to determine if they would be considered a mix in our rescue. This may include additional pictures next to common items (5 gallon bucket, kitchen appliance, a car, etc.) for size references.
  
  YesNo
- Dog's Weight*
- Color of Dog*
- Markings
- Gender*
  
  MaleFemale
- Is the dog spayed or neutered*
  
  YesNoI am not sure
- Has the dog been gastropexied/had its stomach tacked?*
  
  YesNoI am not sure
- Is the dog microchipped?
  
  YesNoI am not sure
- Ears
  
  NaturalCropped
- Note: We will not process your surrender form until we receive at least 1 photo. If the photos will not upload, you can email them to rehome@rmgreatdane.org
- Please upload a picture of this dog (1 of 3)
  
  Upload a File
  
  Cancelof
- Please upload a picture of this dog (2 of 3)
  
  Upload a File
  
  Cancelof
- Please upload a picture of this dog (3 of 3)
  
  Upload a File
  
  Cancelof
- Please explain why you are surrendering the dog.*
- If we could help you resolve this issue, would you be interested in keeping this dog?*
- When does the dog absolutely need to be placed? Please note- surrendering is not a quick or speedy process- it may take several weeks to several months to place a dog, depending on the circumstances, but we try our best.*
  
  1-2 weeks3-4 weeks1-3 monthsOther
- How long have you owned the dog?*
- What do you know of the dog's history prior to your own?*
- Has the dog lived in any other states outside of its current state of residence? If so, where?*
- Where did you acquire the dog?*
  
  BreederBorn in my HomeFound as a StrayAnimal Shelter / RescueFriend or RelativePet StoreNewspaper Ad / Internet PostingRocky Mountain Great Dane Rescue, Inc.Other
- If you answered "Breeder" above please include the Breeder's contact information
- If you answered "Breeder" or "Shelter/Rescue" above have you contacted them?
  
  YesNo
- If yes, please let us know who you spoke with, the date, and the reason you were given that they were unable to take this dog back?
- Name, Address, State and Phone of Rescue/Shelter
- If you adopted the dog from RMGDRI, please list the date of adoption and the dog's name at the time of adoption.
- Has the dog seen a veterinarian at least once a year?*
  
  YesNoI am not sure
- Is the dog current on vaccinations? (rabies and distemper/parvo)*
  
  YesNoI am not sure
- Is this dog currently on heartworm prevention?*
  
  Yes- year-roundYes- but only in warm monthsNoOther
- If the dog has been spayed or neutered, at what age were they spayed or neutered?
- If the dog is a female and has not been spayed, when was her last heat cycle?
- Veterinarian's name (to obtain vet records)*
- Veterinary office address*
- Veterinary office phone number*
- If the pet has been to more than one veterinarian, please include the contact information for the additional veterinarians.
- Has the dog ever required any surgeries?*
  
  YesNoI am not sure
- If yes, please explain
- Has the dog ever been diagnosed with, or treated for, any of the following (check all that apply):*
  
  AllergiesEpilepsy or SeizuresBloat/GDVDilated cardiomyopathyWobbler's SyndromeHip or elbow dysplasiaOrgan failure or dysfunctionHeartwormThyroid diseaseBroken or fractured bonesDental disease or broken teethUrinary issues, incontinence, or markingHeart murmurHit by a carEntropion/Ectropion or any eye issues or blindnessMore than 1 ear infectionFecal incontinenceMegacolon or megaesophagusAny neurological concernsHearing impairment or deafnessOther
- If diagnosed with anything medically or any of the above, please use this space to elaborate:
- Does the dog have any lumps, bumps, wounds, scars, skin tags, or anything abnormal externally?*
  
  YesNo
- If you answered "yes" to the above question, please explain the location, size, and any medical diagnosis (if any) related to it. Please list all lumps/bumps/wounds/scars/skin tags/etc.
- Does the dog need any medications, supplements, or special diets?*
- What are you currently feeding your dog? Please list the brand of the food. *
- How often do you feed the dog and how much do you feed them per meal?*
- Is there anything else medically that we, or an adoptive family, should know about the dog?*
- How would you describe the dog most of the time? (check all that apply)*
  
  Very ActiveCouch PotatoTalkativeQuietPlayfulFriendly to FamilyShy to FamilyFriendly to VisitorsShy to VisitorsA ClownAffectionateLap DogFearfulIndependantMore Like a PersonFearlessAloofWithdrawnSolitaryOther
- Does the dog have any form of anxiety, such as separation anxiety or anxiety in general?*
  
  YesNoOther
- 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 much interest in playOther
- Does the dog have any favorite toys or activities? If so, please explain.
- What level of energy does your dog have?*
  
  High/puppy energy- runs and plays constantlyModerate energy- runs and plays oftenMild energy- runs and plays occasionallyLow energy- very low energy indoors and outdoors
- What sort of exercise do you provide your dog? (this is to help us determine what sort of foster home the dog may need)*
  
  NoneMild- a walk once a week or lessModerate- 2-4 walks per weekHigh- at least 5 walks per week or moreOther
- If taken on walks, how does the dog do on leash?*
- What type of collar does the dog use for walks?
- What type(s) of training has this dog had?*
  
  Obedience classHome trainingProfessionalNoneOther
- Does this dog know the basic commands?(check all that apply)*
  
  SitStayComeLie downDoes not know basic commandsNeeds work on basic commandsOther
- Does this dog know any tricks?
- How would you describe your household?*
  
  ActiveNoisyQuietAverageOther
- What areas of your home did the dog have access to? (check all that apply)*
  
  Inside house with access to outsideInside at nightIndoors in cold weatherBarn or shedOutdoors onlyGarage or basementScreened PorchOutdoors in warm weatherOther
- Where does the dog spend most of his/her time? (check all that apply)*
  
  BedroomKitchenLiving roomWhere people areOutdoorsBarn/shedCrateGarage or basementOther
- Is your yard fenced?*
  
  YesNo
- If your yard is not fenced, how have you kept the dog confined to your property?
- Has the dog repeatedly escaped from the yard?*
  
  YesNo
- If the dog escapes from the yard, how does the dog escape?
  
  Digs outChews throughJumps fenceOpens gateCharges gate when openOther
- Is the dog crate trained?*
  
  YesNoI am not sure
- Is the dog destructive if left alone with free roam of the room/house?*
  
  YesNo
- Where do you leave the dog when no one was home?*
- How many hours a day, on average, does the dog spend unsupervised?*
- Where is the dog used to sleeping?*
  
  Owner's roomOwner's bedDog houseGarage/basementCratePatioOutsideFurnitureOther
- What ages of people lived with the dog?*
  
  Adult menAdult womenSeniorsChildren, under 7 years oldChildren, over 7 years oldOther
- Is this dog most comfortable with :*
  
  WomenMenKidsTeenagersSeniorsLoves all peopleOther
- Has the dog regularly been around children?*
  
  YesNoI am not sure
- If the dog lived with children, please provide the age of the children.
- If this dog lived with children under age 7, how did they interact? (check all that apply)
  
  Dog actively avoided childrenChild could pet the dogDog & child played togetherDog growled at childIgnored each otherDog was afraidMutual adorationDog seemed snappyDog too much for small childrenOther
- Has the experiences with the child(ren) always been positive?*
  
  YesNo
- If no, please explain:
- Has the dog ever been exposed to, or lived with, other dogs?*
  
  YesNo
- If the dog lived with other dogs, how did they interact? (check all that apply)
  
  Adored each otherPlayed with each otherSlept near each otherAvoided each otherPeacefully coexistedSniffed nosesFought without injuriesFought with injuriesAte well togetherGroomed each otherRough with each otherHad to be separated at feedingOther
- Has the experiences with other dogs always been positive?
  
  YesNo
- Has the dog ever been exposed to, or lived with, cats?*
  
  YesNoI am not sure
- If the dog lived with cats, how did they interact? (check all that apply)
  
  Adored each otherPlayed with each otherSlept near each otherAvoided each otherPeacefully coexistedCat rubbed on the dogFought without injuriesFought with injuriesCaused the cat stressGroomed each otherRough with the catGentle with the catOther
- Has the experiences with cats always been positive?
  
  YesNo
- If no, please explain:
- Has this dog ever bitten another animal?*
  
  YesNoOther
- If yes, please describe the incident(s) and extent of injuries.
- Is the dog frightened by anything? (check all that apply)*
  
  MenChildrenBroomsThunderFireworksHatsBalloonsVacuumsLarge TrucksBicyclesWaterHandsFeetAppliancesNot FearfulOther
- When does the dog escape?
  
  All the timeWhen left aloneOther
- Is the dog housetrained?*
  
  YesNo
- How often does the dog have accidents in the house?*
  
  Once a dayOnce a weekNeverEvery time the dog is insideOther
- If no, has the dog been examined to rule out any underlying medical problems?
  
  YesNo
- If yes, what was the outcome?
- If the dog has accidents in the house how have you dealt with this problem?
  
  Dog is only allowed in certain areasDog is kept outside onlyOther
- Does this dog chase anything?*
  
  PeopleChildrenCatsLivestockCarsBicyclesSkateboardsWildlifeLivestockOther
- Is this dog a barker?*
  
  YesNoOther
- If yes, please explain the circumstances
- What other animals has the dog lived with? If they have lived with other dogs or cats, please provide if the other dog or cat is male or female and their age. *
- Does the dog get along with other animals? (click all that apply)*
  
  Dog (male)Dog (female)Cats (indoor)Cats (outdoors)BirdsPoultry/LivestockHas not been around other animalsOther
- What types of animals does the dog not get along with?
- When leashed does this dog lunge at other dogs?*
  
  YesNo
- When leashed does this dog lunge at people?*
  
  YesNo
- Is this lunging the dog wanting to play?
  
  YesNo
- Do you feel the dog is overprotective*
  
  YesNo
- Has the dog ever tried to attacked or bite a person or animal?*
  
  YesNo
- If you answered "yes" above, please explain
- Are there any quirks or habits of the dog that you are not fond of?*
- Is there anything else we should know about the dog?
- Please describe the "perfect" home for this dog, or what the home has/doesn't have for this dog to thrive.*
- Tell us something you truly love about the dog.*
- How did you hear about RMGDRI?*
  
  InternetAnimal ShelterPet DirectoryNewspaperPublic AppearanceOther
- It is understood that Rocky Mountain Great Dane Rescue, Inc. does not buy or pay for dogs. This is a service to help place Great Danes in new homes when their present owners can no longer keep them. This service is free, however a donation to help pay for expenses is greatly appreciated as we are a nonprofit rescue and rely heavily on our donors to continue saving the lives of the Great Danes that come into our care. Any amount, small or large, is helpful and can be made on our website or via check sent to P.O. Box 280368, Lakewood, CO 80228.
- ROCKY MOUNTAIN GREAT DANE RESCUE, INC. OWNER SURRENDER AGREEMENT
  
  READ, ACCEPT AND DATE THE FOLLOWING
  
  I hereby make available for adoption, the dog named below on this form, 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 herby forever release, discharge and agree to hold harmless and indemnify the Rocky Mountain Great Dane Rescue, Inc., its board of directors, its members, officers, and agents from all claims, demands, actions, causes of action or liablity of any kind whatsoever arising as a result of or in connection with the adoption or other disposition of the named dog.
- Print the name of the dog you are surrendering*
- I certify that I am the lawful owner of this dog that I am surrendering*
  
  YesNo
- As of today's date, I certify that I am over 18 years of age.*
  
  YesNo
- I certify by selecting yes that I fully understand and accept the terms and conditions of the RMGDRI Owner Surrender Agreement above.*
  
  YesNo
- Surrendering Owner Signature-
  
  Clear
- I would like to release my email address to the new owner of this dog and allow the new owner to contact me if they wish to gain further information on this dog.*
  
  YesNo
- Today's Date
- E-mail
- I understand that I will be communicated via the above provided email. The Incoming Coordinator tries to make contact within 1-3 days of form submission. Sometimes our emails end up in spam/junk boxes, so I will check my spam/junk boxes frequently. If I am having trouble in any way, I can email rehome@rmgreatdane.org.*
  
  Yes, I understand.
- Reply to email
- Should be Empty:

Owner Surrender Form

Note: We will not process your surrender form until we receive at least 1 photo. If the photos will not upload, you can email them to rehome@rmgreatdane.org