Forever Friends Golden Retriever Rescue: Surrender Application

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Dog Surrender Application

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If you have found a Golden Retriever, please contact your local animal control officials for instructions on handling the animal and how to determine ownership. You may also contact our hotline (805-222-6059) for help. FFGR Rescue cannot take in stray dogs directly. This surrender application must be filled out by the owner of the dog or an authorized agent of the owner.
Date
First Name *
Last Name *
Home Phone *
Cell Phone
Email
Address *
City *
State
Zip Code *
1. What is the name of the dog?
2. Is this a purebred Golden, and if not, what is the mix?
3. If it is a purebred, do you have its AKC papers?	Yes No
4. What is its birth date or estimated age?
5. How long have you owned the dog?
6. What is the sex and spay/neuter status?	Female Spayed Not spayed Unknown if spayed Male Neutered Not neutered Unknown if neutered
7. What is its color? Markings?
8. What is its weight?
9. Which vaccinations are current?	Rabies DHLPP Bordetella Unknown on any
10. Does it have any physical or health issues such as allergies and if so, is it on medication? What kind? *
11. Who is your veterinarian (name, address and phone number)? *
12. Will you provide vet records or sign a release so we can obtain them?	Will provide records Will sign a release
13. Is the dog microchipped? If so, which company and microchip number.
14. Is the dog licensed? If so, which county and when does it expire?
15. What training has the dog had?	House-trained Leash-trained Crate-trained Trained for basic commands
16. Does the dog know any tricks or skills commands?
17. Where does the dog spend most of the day?
18. Where does the dog sleep at night?
19. Has the dog lived with small children? If so, what ages?
20. Has the dog lived with any of the following? Please check all that apply.	Cats Small dogs Other large dogs Birds Horses Rabbits
21. Does the dog react poorly to any of the following? Check all that apply.	Small dogs Other large dogs Children Strangers Men Women Loud noises, fireworks Being alone in house Being alone in yard Riding in car
22. Please check any habits that apply:	Digging Excessive barking Jumping fences Jumping on people Pulling on the leash Showing fear of noises Showing food, toy possessiveness Chewing Exhibiting separation anxiety Chasing cats, small animals
23. Has the dog bitten a person or other animal? If yes, please describe.
24. Did the bite require medical attention?	Yes No Not applicable
25. Was the bite reported to animal control?	Yes No Not applicable
26. What is its favorite activity?
27. Why are you relinquishing your Golden? *
28. Please tell us anything else you feel is important for us to know about your Golden.
29. How did you hear about FFGR Rescue? Check all that apply.	Internet search Online petfinder website Craigslist Friend/family Veterinarian Pet store/service Other business Animal shelter/other rescue Facebook/Twitter Newspaper/pet paper TV/radio Other
Please read, sign, and date. I, ________________________________, hereby make available for adoption through Forever Friends Golden Retriever Rescue of Ventura County the Golden Retriever named ______________ who is (age) _________. I certify I am the owner of this dog, free and clear of all other interests. I certify that this dog is not possessed of any dangerous or vicious propensities and I have not willfully concealed information about this dog that may indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify Forever Friends Golden Retriever Rescue of Ventura County, its Board of Directors, foster home providers, volunteers and agents from all claims, demands, actions, causes of action or liability of any kind whatsoever arising as a result of or in connection with the adoption of the above named dog, and/or any harm or injury caused by such dog as a result of our offering such dog for adoption, or whatever kind or nature. I further understand and acknowledge that: (1) Despite my offering this dog for adoption, no such adoption may prove possible for this dog because of either terminal illness causing pain or over-aggressiveness toward people that cannot be cured; (2) FFGR Rescue may have no choice but to put this animal to sleep should either of those conditions obtain; and (3) my above release, discharge and agreement to hold harmless and indemnify FFGR Rescue, its Foster Home Providers, Volunteers, and agents will also extend to, and cover, those events that may occur after I have delivered this animal to FFGR Rescue for adoption through and until such time as this dog is put to sleep if adoption proves not to be possible for either of the above reasons.
Signature Required:
Date:

Date
First Name *
Last Name *
Home Phone *
Cell Phone
Email
Address *
City *
State
Zip Code *
1. What is the name of the dog?
2. Is this a purebred Golden, and if not, what is the mix?
3. If it is a purebred, do you have its AKC papers?
4. What is its birth date or estimated age?
5. How long have you owned the dog?
6. What is the sex and spay/neuter status?
7. What is its color? Markings?
8. What is its weight?
9. Which vaccinations are current?
10. Does it have any physical or health issues such as allergies and if so, is it on medication? What kind? *
11. Who is your veterinarian (name, address and phone number)? *
12. Will you provide vet records or sign a release so we can obtain them?
13. Is the dog microchipped? If so, which company and microchip number.
14. Is the dog licensed? If so, which county and when does it expire?
15. What training has the dog had?
16. Does the dog know any tricks or skills commands?
17. Where does the dog spend most of the day?
18. Where does the dog sleep at night?
19. Has the dog lived with small children? If so, what ages?
20. Has the dog lived with any of the following? Please check all that apply.
21. Does the dog react poorly to any of the following? Check all that apply.
22. Please check any habits that apply:
23. Has the dog bitten a person or other animal? If yes, please describe.
24. Did the bite require medical attention?
25. Was the bite reported to animal control?
26. What is its favorite activity?
27. Why are you relinquishing your Golden? *
28. Please tell us anything else you feel is important about your Golden.
29. How did you hear about FFGR Rescue? Check all that apply.
Please read, sign, and date. I, ________________________________, hereby make available for adoption through Forever Friends Golden Retriever Rescue of Ventura County the Golden Retriever named ______________ who is (age) _________. I certify I am the owner of this dog, free and clear of all other interests. I certify that this dog is not possessed of any dangerous or vicious propensities and I have not willfully concealed information about this dog that may indicate such propensities. The information I have provided about this dog is true and complete. I hereby forever release, discharge and agree to hold harmless and indemnify Forever Friends Golden Retriever Rescue of Ventura County, its Board of Directors, foster home providers, volunteers and agents from all claims, demands, actions, causes of action or liability of any kind whatsoever arising as a result of or in connection with the adoption of the above named dog, and/or any harm or injury caused by such dog as a result of our offering such dog for adoption, or whatever kind or nature. I further understand and acknowledge that: (1) Despite my offering this dog for adoption, no such adoption may prove possible for this dog because of either terminal illness causing pain or over-aggressiveness toward people that cannot be cured; (2) FFGR Rescue may have no choice but to put this animal to sleep should either of those conditions obtain; and (3) my above release, discharge and agreement to hold harmless and indemnify FFGR Rescue, its Foster Home Providers, Volunteers, and agents will also extend to, and cover, those events that may occur after I have delivered this animal to FFGR Rescue for adoption through and until such time as this dog is put to sleep if adoption proves not to be possible for either of the above reasons.
Signature Required:
Date: