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

Month Day Year
Date
Email *
First Name *
Last Name *
Physical Address *

Street Address

Street Address Line 2

City State / Province

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

Street Address

Street Address Line 2

City State / Province

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

Yes No
Upload Photos

Browse Files

Cancel of
AKC/UKC/CKC/Other registered name? *

Yes No
Registration Number and Registry
Microchip or tattoo? *

Yes No
Number and Registry
Is the GSP male or female? *

Male Female
GSP Coloring (click all that apply) *

White Liver Black Ticking Patches
Where did you obtain your GSP? (click one) *

Breeder GSP Rescue Other Rescue Shelter Previous 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? *

Yes No
Cratetrained? *

Yes No
Is crating required? *

Yes No
Does GSP have separation anxiety? *

Yes No
Describe Extent, Situation, or Your Routine Change(s)
Can GSP be left unattended? *

In house In crate In yard In car
Is GSP leash-trained? *

Yes No
Does GSP have any obedience training? *

Yes No
Describe
Does GSP have any hunt training? *

Yes No
Describe
What dog food brand do you feed GSP? *
Any physical, medical, or behavioral issues? *

Yes No
Please Describe
Veterinarian's Name
Veterinarian's Address

Street Address

Street Address Line 2

City State / Province

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

Yes No
Last Vaccination for Rabies

Month Day Year
Date
Last Vaccination for DHLLP

Month Day Year
Date
Last Vaccination for Bordatella

Month Day Year
Date
Last Vaccination for Lyme Disease

Month Day Year
Date
Last Test for Heartworm Disease

Month Day Year
Date
Last Test for Tick-Borne Diseases

Month Day Year
Date
Last Fecal Test

Month Day Year
Date
Is GSP on heartworm, Lyme, flea preventives? *

Yes No
How does GSP react to children? *

Well Not Well
How does GSP react to other dogs? *

Well Not Well
How does GSP react to strangers? *

Well Not Well
How does GSP react to cats or small animals? *

Well Not Well
What does GSP like best? *
What does GSP like least, or fear? *
Has GSP bitten a child or adult? *

Yes No
Describe
Has GSP bitten another dog?

Yes No
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 *

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

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

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

Agree Don'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 *

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

Agree Don'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.

Agree Don't Agree
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. *

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

Agree Don't Agree
Date

Month Day Year
Date
Should be Empty: