First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County

Email*

Home Phone*

Work Phone
x

Cell Phone*

How did you hear about us? (IF on a computer, please hold the "Control" key down while selecting multiple options.)
Choose all that apply: GPPR Facebook GPPR Website Instagram National Great Pyrenees Rescue Petfinder Referral Twitter

What is your dog's name that you are surrendering:*

Estimated Age of Dog: *

Gender of dogs:
Choose all that apply: Female Male

Is this pet spayed / neutered?

Does your dog have a microchip - if yes, please list the vendor of the microchip and the microchip number:*

Does your dog have double dew claws?

We understand that no dog is perfect. Please answer the following questions as honestly and accurately as possible so that we may better help in placing this dog in the best possible environment. (IF on a computer, please hold the "Control" key down while selecting multiple options.) Is this dog best suited to be a:
Choose all that apply: House Dog Livestock Guardian Dog Outdoor only dog Only Dog

Does your dog have AKC / CKC papers?

Dog's Description: Please describe the color and markings (white, white with grey badger face etc.)*

What is the current weight of your dog:*

If the dog came from Great Pyrs & Paws Rescue, or National Great Pyrenees Rescue, or an affiliate of that rescue, please list the dog's name at the time of adoption, the date and what state the dog came from:*

If the dog came from a breeder, please list the name, city, state and contact information for the breeder:*

If the dog came from another rescue or shelter, please list the name, city, state and contact information for that organization:*

If the dog came from a pet store, please list the name, city, state and contact information for the store:*

If this dog is a stray, please know that we follow the state guidelines for "lost dogs", and will require proof that every effort has been made to find the owner. Describe how you found the dog and whether you have made any attempt to search for the owner. (Ex. put up posters, search for owner on Craig's list, notify local shelter, etc.) List any methods used.*

What are your reasons for surrendering the dog:*

Where does the dog currently spend the majority of his/her time:*

How long have you had this dog?*

Where does the dog currently sleep?*

How are you currently containing the dog, or keeping the dog (fence, invisible fencing, kennel, crate, not contained, etc)*

If the dog is contained by a fence, please indicate height and type of fence:*

What is the dog fed? Please indicate can or dry, brand (Purina ONE, Purina ProPlan, Alpo, whatever was left over from dinner etc.) and quantity and how often.*

Does this dog come when called?

What would you describe as the activity level of this dog:

Has the dog ever escaped or jumped a fence, select those that apply (IF on a computer, please hold the "Control" key down while selecting multiple options.):
Choose all that apply: Escaped out door Jumped over fence Dug / Tunneled under fence Jumped out window (Glass) Jumped out window (Screen) Damaged fence to escape

If the dog has jumped a fence, please indicate height of fence and type of fence that the dog has escaped from (stockade, picket, wire, electric etc.)*

Will this dog run away if loose?

Is this dog crate trained?

If the dog is crate trained, please indicate how often, how long, and the last time the dog used the crate:*

Is this dog house trained?

Does this dog walk nicely / quietly on a leash?

Does this dog get along with cats safely (select all that apply):
Choose all that apply: Does not like cats (not safe) Likes Inside Cats Likes All Cats

Does the dog get along safely with other dogs? (select all that apply)
Choose all that apply: Female dogs only Male dogs only Large dogs only Small dogs only All dogs are friends Does not like other dogs Unsure

Does the dog get along safely with children? (select all that apply)
Choose all that apply: Children over age 12 Children over age 6 Children ages 2-6 Children of all ages Unsure Not good with children

Does the dog get along safely with strangers? How does he / she react with strangers (select all that apply):
Choose all that apply: Protective Aggressive Fearful Growls Hides Wags Tail Introductions required Friendly Unsure

When food or treats are present, does the dog (select all that apply - IF on a computer, please hold the "Control" key down while selecting multiple options.):
Choose all that apply: Allows dogs near food Allows people near food Aggressive with dogs Aggressive with ppl Will share food Will share bones / treats Protective of bones / treats

Is your dog destructive when left home alone

Please describe how your dog is destructive and when he becomes destructive:*

Does your dog become anxious when left home alone:

Please describe your dog's behavior when left alone (anxious if left in the home alone, anxious if tied outside and you leave, etc.)*

Is there a history of aggressive behavior towards people?

If you answered yes, please describe the aggressive behavior:*

Is there any history of aggressive behavior with other animals?

If you answered yes, please describe the aggressive behavior and type of animal involved:*

Please tell us everything you can about the dog's history, personality traits, training, quirks, etc. that you would like to include:*

If you have other dogs, please list: Breed, Age, Sex, and whether spayed or neutered*

Do you currently own other pets? (cats, guinea pigs, birds, etc.) If so, please indicate type of animal, age, sex, and if spayed or neutered*

What is your Veterinarian's name?*

What is your Veterinarian's Phone Number?*

Please answer the following questions about the dog's health to the best of your ability. If you don't know the date of a vaccination or test, simply say "unsure" or "don't know" Does the dog have: (Select all that apply - IF on a computer, please hold the "Control" key down while selecting multiple options.)
Choose all that apply: Addison's Disease Arthritis Diabetes Ehrlichiosis Environmental Allergies Food Allergies Heartworm Disease Hip / Leg / Joint Problems Lyme Disease Prone to Ear Infections Skin Issues Glaucoma / Eye issues Heart murmur

For every box selected, please give details on when diagnosed or what treatment plans have been done or have been recommended:*

Date of last Bordatella vaccination and expiration date, or any other vaccinations that the dog may have had:*

Date Flea/Tick preventative last applied and type (K9 Advantix, Trifexis, Frontline etc.)*

Date of Last fecal exam for worms and Date/Type of worming (if applicable)*

What is the date of the last heartworm test, and is this dog being given regular heartworm prevention medication? If yes, what is the type of prevention being given and when was the last date given?*

If GPPR does agree to accept the transferred ownership of this dog, please check the following that will apply:
Choose all that apply: AKC Papers will be given Vet Records will be given CKC Papers will be given NO VET RECORDS NO AKC RECORDS NO CKC RECORDS

How long are you able to hold the dog you want to surrender?*

Can you help transport the dog to the foster location:

Submission of this form is not a transfer of ownership nor a contract between Great Pyrs & Paws Rescue & myself. Submission of this form does not imply a guarantee that GPPR will accept my dog for re-homing. I acknowledge & accept this statement by typing my name here: *

I understand that I must email a picture of my dog to greatpyrsandpaws@gmail.com or send the photo through Facebook Messenger to our Facebook page for this application to be considered by GPPR . Please include your name and the name of the dog with any photo submissions. I agree to this statement by typing my name here:*

As part of the evaluation for accepting your dog, we will contact your listed veterinarian. I hearby provide authorization to release veterinary information and medical records regarding my pets to representatives of Great Pyrs & Paws Rescue. (please initial here to agree)*

By submission of this information, and my(our) initials in the following box, I(we) attest that I currently have ownership of this dog, have made a serious effort to find the owner of the dog if he/she is a stray and that the information provided on this application is true and accurate to the best of my(our) knowledge. I(We) understand that completion and submission of this form does not constitute a transfer of ownership nor that Great Pyrs & Paws will accept my(our)dog as a candidate for re-homing. Should GPPR decide to accept the dog into its owner surrender program, I (we) agree that upon written notice of acceptance into the program, that I(we) will work with the rescue in good faith to help them rehome my(our) dog (please type your name here):*