Surrender Form

Arkansas Weimaraner Rescue

Individual or Couple *
Primary First Name *
Primary Last Name *
Secondary First Name *
Secondary Last Name *
Address *
City *
State *
Zip Code *
Primary Phone Number *
Primary Email Address *
Secondary Phone Number *
Secondary Email Address
Pet's Name *
Species of pet
Sex of pet *
Breed of animal (best guess) *
Second Breed (best guess)
Color of pet *
Pet Age (.3 = 3 months, .6 = 6 months, 1 = 1 year) *
Pet's weight *
Size as adult *
Owner Surrender or Stray? *
Are you the original owner? *
How long have you had the dog? If the dog has moved from home to home, please describe. *
Reason for giving up pet *
Reason category *
Your veterinarian name and phone number *
Are the records at the Vet Clinic in your name or someone else’s?
Please give the FIRST & LAST Name of the person the records are under at the vet clinic. *
What shots have been given to the dog? Please include dates. *
Has the dog been tested for heartworms? *
When was the last heartworm test done? *
When was the last heartworm test done? *
What day of the month is the heartworm pill given on? *
Is the dog tattooed or microchipped? *
Spayed or Neutered? *
Has the dog ever been used for breeding? *
Has the dog been checked for hip dysplasia? *
Special medications or needs? *
Has the dog ever had a seizure? *
Explain your feeding schedule with the dog, brand of food, and amount. *
Where does the dog stay when you are gone? (Crate, free in house, outside, etc.) *
How many hours is the dog left alone? *
House broken? *
Crate Trained? *
Please explain any bad habits the dog may have. Examples: Fence jumping, chewing, chasing cars,etc. *
Special activities or things the dog enjoys? *
Has the dog ever bitten anyone? *
If yes, please give the circumstances. *
Is the dog good with other dogs? *
Is the dog good with cats? *
Is the dog good with Children? *
What age of child does the dog do best with? *
If not good with children, please explain. *
Is the dog good with men? *
Is the dog good with women? *
How often do you take this dog out in public? *
How often does this dog get to meet new people either in your home or elsewhere? *
How often does this dog interact with dogs that do not live with you? *
Are you comfortable taking this dog outside of your home on a leash to walk or run? If no, why? *
Is this dog good on a leash? *
Does the dog become aggressive when it is on a leash? *
Can you take items such as a toy or bone from this dog without incident? If no, please explain. *
Picture of dog (Required)
Attach additional picture
Staff Only
The laws of Arkansas will govern the interpretation and enforcement of this contract. I certify that I am the sole owner of the dog described above and that I have the right to give it away. I further certify that there are no unpaid veterinary bills or claims on said dog. I hereby renounce any and all claims to the above described Weimaraner. It is my understanding that the Arkansas Weimaraner Rescue Committee will do what is best for the dog. With this instrument the dog becomes the property of the Arkansas Weimaraner Rescue. My name and/or phone number may be given to the new owner of this dog, so that the new owner may contact you (previous owner) if they wish to gain more information on this dog. By typing my name below I use that as my electronic signature. *AWR may have you sign this release in person as well.
E-Signature (type full name) *

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