Southwest German Shepherd Rescue
and
White German Shepherd Rescue

We receive surrender forms on a daily basis. Unfortunately we do not have the time or staff to contact everyone in order to fill in the blanks for unanswered questions. We would rather devote our time to finding your dog the perfect home; we take that responsibility very seriously. Every answer you provide is important.

YOU WILL BE UNABLE TO SUBMIT YOUR FORM WITH UNANSWERED QUESTIONS AND/OR MISSING INFORMATION. Please answer all completely and honestly, wait 24 hours for us to review, then call us per the instructions provided at the end of this form. THANKS

If you wish to rehome more than one dog, please compete a SEPARATE FORM for each.

DO NOT USE THIS FORM FOR RECENTLY FOUND STRAYS - SEE I Found a Stray GSD

OWNER SURRENDER QUESTIONNAIRE

  


Please provide us with the following information - you will be unable to submit your form with unanswered questions and/or unless all information is provided.

Legal Owner's Name:  

Home Email Address:  

Phone Number (Day):     (Evening):      Cell Phone:  

Home Address:  (ARIZONA ONLY*) 

(*We are not able to accommodate dogs we cannot have access to as in outside of Arizona)

City:   State:   Zip Code:  

What are the major cross streets where dog is being kept?  

Your Dog's Name:  

Is your dog a purebred GSD or a mix?:    Purebred     Mix     Unanswered

If a mix, STOP! WE ARE ACCEPTING ONLY PUREBRED GERMAN SHEPHERDS AT THIS TIME.

Male or female?:    Male     Female

Spayed or Neutered?:     No     Spayed     Neutered     Unknown     Unanswered

If intact, are you willing to have your pet spayed or neutered?:     Yes     No     Unanswered

Dog's Age or Date of Birth:

Dog's Primary Color(s):

Is your dog current on all vaccinations?:    Yes     No     Unanswered

HAS YOUR DOG BEEN VACCINATED FOR RABIES WITHIN THE LAST 3 YEARS?:    Yes     No     Unanswered

Expiration of rabies:    (This information MUST be provided. If your dog does not have a current rabies vaccination, we will ask you to obtain one.)

Do both of your dog's ears stand up?:    Yes     No     Unanswered

Is your dog on Heartworm preventative?:    Yes     No     Unanswered

When was your dog last tested for Heartworm?:

Does your dog have a microchip or tattoo?:    Yes     No     Unanswered

Brand (Avid, Home Again, etc.) and number of chip:

Do you have AKC or SV papers on your dog?:    Yes     No     Unanswered

Where did you get your dog from?:     Breeder      Shelter      Rescue Group      Found as a Stray      Classified Ad      Friend, Relative or Neighbor      Unanswered

If from a breeder, the breeder's name and/or kennel name:

How long have you had this dog?:    Under 3 mos     3-6 mos     1-2 yrs     2-5 yrs     All its life      Unanswered

EXACTLY where do you keep the dog when you are not home? (Please be specific, i.e., loose outside, outside in a kennel, indoors free, indoors in a crate, in the laundry room, etc.:

Is this an indoor or an outside dog?:    Indoors     Outside     Unanswered

EXACTLY where does your dog sleep at night?:

Is your dog reliably housebroken?:    Yes     No     Unanswered

Is your dog crate trained?:     Yes     No     Unanswered

Is your dog destructive?:    Yes     No     Unanswered

Has your dog ever been left loose in the house while no one was home?:    Yes     No     Unanswered

Does your dog panic when left alone (i.e., barking, pawing at blinds or under doorways, scratching on doors, escaping, vocalizing, eliminating and otherwise manifesting separation anxiety?:    Yes     No     Unanswered

If YES, please describe:

Has your dog had ANY formal (obedience) training/classes?:    Yes     No     Unanswered

If yes, where, when and with whom?:

Is your dog well socialized (i.e., FREQUENTLY taken OFF its home property and exposed to strangers, strange dogs, strange things and public places?:    Yes     No      Unanswered

Do you walk this dog often?:    Yes     No     Unanswered

If yes, how often and for how long?:

If yes, do you usually walk to the same place most, if not all, of the time?:     Yes     No     Unanswered

Does your dog walk well on a leash or does he/she pull?:    Yes     No, pulls    Unanswered

How well does dog ride in a vehicle?   Very well     Gets carsick     Paces or vocalizes     Jumps in the front seat      Unanswered

If no, please explain (i.e., gets car sick, jumps in the front seat, etc.):

Please tell us if your dog has had regular contact with the following:

KIDS:    Yes     No      Unanswered

If yes, does dog interact with them?:

TODDLERS (4 and under):    Yes     No      Unanswered

If yes, how does dog do with toddlers?:

CATS:    Yes     No      Unanswered

If yes, how do they get along?:

SMALL DOGS:    Yes     No      Unanswered

If yes, how do they get along?:

UNFAMILIAR/STRANGE DOGS:    Yes     No      Unanswered

If yes, how does your dog get along with strange dogs?:

Do you have any other pets (i.e., ferrets, reptiles, horses, livestock, etc.)?:    Yes     No      Unanswered

What other Pets do you have?:    Dog(s)     Cat(s)     Ferret(s)     Livestock     None    

How does your dog get along with EACH?:

If you had to use TWO of the following words ONLY, how would you describe your dog?

Submissive
Dominant
Aggressive
Fearful
Confident
Skittish/Shy
Nervous/Neurotic
Overly Protective

Does your dog bolt or escape often?:    Yes     No     Unanswered

If yes, please explain:

Does your dog have any health issues, including allergies?:    Yes     No     Unanswered

If yes, please elaborate:

Is your dog on any medication?:    Yes     No     Unanswered

If yes, please elaborate:

Was your dog ever tested for Valley Fever?:    Yes     No     Unanswered

Was your dog ever diagnosed with or treated for Valley Fever?:    Yes     No     Unanswered

If yes, please elaborate:

Does your dog have hip dysplasia or arthritis?:    Yes     No     Unanswered

Have your dog's hips ever been x-rayed??:    Yes     No     Unanswered

If so, at what age?:  

Does your dog have any behavioral issues?:    Yes     No     Unanswered

If yes, please elaborate:

Has your dog ever bitten anyone?:    Yes     No     Unanswered

How does your dog typically respond to strangers? (please check all that apply):

Submissive
retreats / fearful
lunges & barks
outgoing and friendly
O.K. if not touched
Growls/aggressive
readily accepts petting
my dog is never exposed to strangers

Has your dog ever attacked another dog?:     Yes     No     Unanswered

Does your dog know how to swim?:    Yes     No     Unknown     Unanswered

Does your dog show a preference for either men or women?:     Yes, Men     Yes, Women     No     Unanswered

Why are you surrendering your German Shepherd Dog? 

Are you able to continue to house and care for this dog while we work to place him/her?:     Yes     No     Unanswered

PLEASE NOTE:
WE ARE FULL!
WE HAVE MANY DOGS ON A WAIT LIST FOR FOSTER SPACE.

In the event you need IMMEDIATE placement for your dog and/or are unable to continue to provide housing for any length of time, it is unlikely that we will be able to help. After evaluating your dog we must find a suitable foster home which takes time, particularly if your dog has behavioral issues.

Most, if not all rescue organizations are full, as are the shelters. If, however, you are able to keep your dog for a period of time or throughout the placement process, we CAN move forward.

**IMPORTANT WARNING!!**
Please click and read above link if you are short on time to re-home your dog

If you cannot continue to house your dog, how much longer can you keep your dog while we endeavor to locate a suitable foster home?:

Are you willing to periodically transport the dog to the north side of Phoenix to be shown to prospective adopters?:    Yes     No     Unanswered

Are you willing to consider training or other assistance to enable you to keep your dog?:    Yes     No     Unanswered

Are you working with any other agencies or rescue groups?:    Yes     No     Unanswered

Has your dog seen a veterinarian in the past 12 months?:     Yes     No     Unanswered

What is the name and location of the veterinary clinic this dog has been to?:

What is the date (month and year) of your dog's last vet visit and the reason for the visit?:

Are you able to bring your dog to us for its evaluation next weekend?:    Yes     No     Unanswered

If not, when?

*Please note: YOU MUST CALL US TO SCHEDULE AN EVALUATION. THE WEEKEND'S EVALUATION SCHEDULE IS FINALIZED BY FRIDAY EVENING, SO YOU MUST CALL BY FRIDAY EVENING.

If you have access to a digital camera, it would be very helpful if you could Email Steff at SWGSDRESCUE@AOL.com several photos (taken outdoors during the day) of your dog. We would prefer a face (front) shot, a standing (side) shot and a sitting (front) shot if possible. JPEG attachments are best.

Please allow 12 hours for us to review the information, then give us a call at 623-516-2880 between 10:00am and 8pm, preferably weekdays.

I understand that nothing will happen until I call to schedule my dog's evaluation:    Yes, I understand

DO NOT WAIT FOR US TO CALL YOU!! WE WILL NOT CALL YOU.

If we are out of the office, please leave a voice mail and we will return local calls. Thank You