German Shorthaired Pointer Rescue PA - Surrender/Relinquishment Form

German Shorthaired Pointer Rescue PA - Surrender/Relinquishment Form
Our organization (GSPRPA) is run exclusively by volunteers. Please read, review and be sure you understand all information and statements before electronically signing and submitting the surrender form. Note all fields must be completed—if an answer does not appear applicable, please fill in with N/A. Applicant must be 18 years old and over.
Date

MonthDayYear
Date
Email*
First Name*
Last Name*
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County*
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Phone*
Best Time to Call*
GSP's Call Name*
GSP's Whelp Date or Age*
Is GSP purebred?*

YesNo
Upload Photos

Browse Files

Cancelof
AKC/UKC/CKC/Other registered name?*

YesNo
Registration Number and Registry
Microchip or tattoo?*

YesNo
Number and Registry
Is the GSP male or female?*

MaleFemale
GSP Coloring (click all that apply)*

WhiteLiverBlackTickingPatches
Where did you obtain your GSP? (click one)*

BreederGSP RescueOther RescueShelterPrevious Owner
Please provide contact information
At what age was your GSP when you got him/her?*
What reason(s) you are surrendering the GSP?*
Housetrained?*

YesNo
Cratetrained?*

YesNo
Is crating required?*

YesNo
Does GSP have separation anxiety?*

YesNo
Describe Extent, Situation, or Your Routine Change(s)
Can GSP be left unattended?*

In houseIn crateIn yardIn car
Is GSP leash-trained?*

YesNo
Does GSP have any obedience training?*

YesNo
Describe
Does GSP have any hunt training?*

YesNo
Describe
What dog food brand do you feed GSP?*
Any physical, medical, or behavioral issues?*

YesNo
Please Describe
Veterinarian's Name
Veterinarian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian's Phone
Spayed or neutered?*

YesNo
Last Vaccination for Rabies

MonthDayYear
Date
Last Vaccination for DHLLP

MonthDayYear
Date
Last Vaccination for Bordatella

MonthDayYear
Date
Last Vaccination for Lyme Disease

MonthDayYear
Date
Last Test for Heartworm Disease

MonthDayYear
Date
Last Test for Tick-Borne Diseases

MonthDayYear
Date
Last Fecal Test

MonthDayYear
Date
Is GSP on heartworm, Lyme, flea preventives?*

YesNo
How does GSP react to children?*

WellNot Well
How does GSP react to other dogs?*

WellNot Well
How does GSP react to strangers?*

WellNot Well
How does GSP react to cats or small animals?*

WellNot Well
What does GSP like best?*
What does GSP like least, or fear?*
Has GSP bitten a child or adult?*

YesNo
Describe
Has GSP bitten another dog?

YesNo
Describe
Any additional details to locate best match for your GSP?
I, the undersigned, understand, agree, and certify to the following:
If accepted, I hereby surrender to the German Shorthaired Pointer Rescue PA this German Shorthaired Pointer, named above*

AgreeDon't Agree
I certify that I am the owner of this dog, free and clear of all other interests*

AgreeDon't Agree
I also certify that this dog is not possessed of any dangerous or vicious propensities*

AgreeDon't Agree
The information I have provided about the history of this dog is true and complete to the best of my knowledge*

AgreeDon't Agree
I authorize German Shorthaired Pointer Rescue PA to place this GSP into a new home at their discretion and to the best of their ability*

AgreeDon't Agree
I irrevocably relinquish unto German Shorthaired Pointer Rescue PA all rights title, and interest in and to the GSP surrendered*

AgreeDon't Agree
I hereby forever release, discharge, and agree to hold harmless and indemnity German Shorthaired Pointer Rescue PA, its board of directors, its officers, volunteers, and agents from all claims, demands, actions, causes of action, and liability of any kind whatsoever arising as a result of, or in connection with, the surrender and subsequent adoption or other disposition of this surrendered dog.

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PLEASE READ, REVIEW AND BE SURE YOU UNDERSTAND ALL INFORMATION AND STATEMENTS ABOVE BEFORE ELECTRONICALLY SIGNING AND SUBMITTING THIS SURRENDER APPLICATION/RELINQUISHMENT FORM
By entering my name above and below and submitting this surrender application/relinquishment form, I agree that I have carefully read this agreement and fully understand the contents.*

AgreeDon't Agree
Your Name*
By entering your name electronically, you agree to the above:*

AgreeDon't Agree
Date

MonthDayYear
Date
Should be Empty: