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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. I UNDERSTAND THAT I NEED TO CALL (FOR A BLACK & TAN GSD) OR RESPOND TO AN EMAIL (FOR A WHITE GSD) AFTER I SUBMIT THIS FORM:   (please type "YES" in the blank space if you understand) 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: If from a rescue group, which one, in what state and did you sign a contract?: EXACTLY how long have you had this dog?: 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 How often do you walk your dog? (If not at all, please indicate "NEVER"): 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.): Has or does your dog live with children or toddlers? If so, indicate their ages: How well does your dog interact with children and toddlers?: How well does your dog interact with small or toy breed dogs?: Has your dog lived with cats?: Please elaborate What other pets do you have and how does your dog get along with them? (ferrets, livestock, reptiles, etc.)?: If you had to use TWO of the following words ONLY, how would you describe your dog? Please keep in mind that this is a high energy breed which is not the same as hyperactive. And submissive & confident seldom go hand-in-hand. Submissive Dominant Aggressive Fearful Confident Skittish/Shy Nervous/Neurotic Overly Protective Passive Hyperactive 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: What, if any, medication is your dog on? (If none, please indicate "NONE"): 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? *YOU MUST ENTER AN ACTUAL TIME FRAME (e.g., "3 weeks, 1 month, as long as it takes")*: Have you or do you plan to place a classified ad to market your dog? (Please note: this is potentially very dangerous) 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 to address issues which could enable you to keep your dog?:    Yes     No     Unanswered Are you working with any other agencies or rescue groups?:    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? 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 6 hours for us to review the information, then (if a black & tan GSD) give us a call at 602-866-2880 between 10:00am and 8pm, preferably weekdays. If your surrender form is for a white German Shepherd, you will be contacted via email within 24 hours. YOU MUST RESPOND TO THE EMAIL IN ORDER TO SET UP AN EVALUATION FOR YOUR DOG. *Please note: TO SCHEDULE AN EVALUATION YOU MUST CALL US (IF A BLACK & TAN) OR RESPOND TO THE EMAIL FROM WHITEGSDRESCUE@AOL.COM (IF A WHITE). THE WEEKEND'S EVALUATION SCHEDULE IS FINALIZED BY FRIDAY EVENING, SO YOU MUST CALL OR RESPOND BY FRIDAY EVENING. I UNDERSTAND THAT NOTHING WILL HAPPEN UNTIL I CALL TO SCHEDULE MY DOG'S EVALUATION OR RESPOND TO THE EMAIL IF A WHITE GSD:   (please type "YES" in the blank space if you understand) DO NOT WAIT FOR US TO CALL YOU!! WE WILL NOT CALL YOU. If we do not hear from you within 10 days your dog's file will be closed. If we are out of the office, please leave a voice mail and we will return your call. Thank You We will ask you to disclose everything negative or positive about your dog. We are very candid with our potential adopters. We know that anything, whether it be health or behavior related, will come to the surface eventually. We would much rather deal with such issues up front rather than months after a dog has been re-homed, resulting in their return and yet another displacement. If your dog has a bite history, you (and we) are bound by law to disclose this information. If you don't, you could be liable for a subsequent bite for not having made it known. A bite does not necessarily mean that your dog is not adoptable; many people put German Shepherds in situations they shouldn't and many other factors are taken into consideration...just be honest and forthcoming.