Surrender Form - Rescue a Golden of Arizona

PLEASE NOTE: WE ARE A BREED SPECIFIC RESCUE. WE CANNOT TAKE IN DOGS THAT ARE NOT GOLDEN RETRIEVERS, OR MOSTLY GOLDEN RETRIEVERS. If your dog does not look like a Golden Retriever, we will be happy to provide you with other resources for rehoming your dog. Contact us here.

RAGofAZ also does not accept dogs with a history of biting or aggressive behavior toward people or other animals. Please fully disclose any history of biting, attempted biting, snapping, lunging, or other aggressive behavior on this form.

Based on your dog’s background and needs, we match each dog with the best pre-approved family for their well-being. The following questions help us evaluate your dog and make the best possible match, so complete and honest information is essential. Age, illness, or injury alone does not disqualify a dog from consideration.

Date

First name *

Last name *

Email Address *

Additional Email Address

Street Address *

City

State/Province

ZIP / Postal Code

Preferred phone number *List as home/cell/work

Additional phone number

What is your preferred method of contact? *TextEmailPhone

Are you the current owner? *YesNo

Is there a co-owner? *YesNo

If yes, please list name and contact information if different than above

What is your dog's name? If a pair list both names. *

What is your dog's age? If dogs are a pair, list both ages. Include birthday(s) if known. *

If dogs are a pair, are they bonded (they need to stay together)?YesNoI don't know

Reason for Rehoming? *

Where did you get your dog and how long have you had them? *

If the dog was from Rescue a Golden of Arizona please indicate the original name given to your dog.

If your dog is from another rescue- name of the rescue and location?

If your dog is from a breeder, do they have a return clause?

How would you describe your dog’s current health? RAGofAZ does not discriminate based on health issues. understanding your dog’s health needs enables us to provide necessary care, including spaying, neutering, vaccinations, and testing for any underlying health conditions *Excellent – no known health concernsGood – generally healthyMinor medical issues (allergies, skin issues, ear infections, etc.)Ongoing medical condition(s) requiring medication or monitoringCurrently under veterinary care

Please list any medical conditions, past surgeries, allergies, or medications your dog is currently taking

Is your dog spayed or neutered? *YesNoNot sure

If female and not spayed, when was her last heat cycle?

List their current veterinarian contact information. *

What does your dog eat? How much and how often is your dog fed daily? *

Is your dog housebroken (potty trained)? *YesNo

Can your dog use a dog door? *YesNo

Is your dog crate trained? *YesNo

Where is your dog during the day? *Free run of the houseCratedOutsideOther

Comments

Where is your dog during the night? *Free run of the houseCratedOutsideOther

Comments

How active is your dog? *Low energy / mostly relaxedModerate activityVery active / needs lots of exercise

Does your dog take food from counters or tables? *YesNo

Does your dog like to dig? *YesNo

Does your dog need protective restraining when opening the front door? *YesNo

Does your dog enjoy chewing anything besides toys, such as household items? *YesNo

Does your dog look for adventure by attempting to jump over or dig under fences/walls? *YesNo

Does your dog bark frequently or alert bark? *YesNo

How does your dog respond to loud noises (thunder, fireworks, construction)? *UnbotheredMildly nervousVery fearful (hides, shakes, etc.)Attempts to escapeNot sure

Does your dog ride well in a car? *YesNo

Does your dog get car sick? *YesNo

Will your dog playfully mount other dogs? *YesNo

Which of the following behaviors describe your dog? *Check all that applyLoves carrying toys or objects aroundSteals socks or household itemsVery energetic / needs lots of exerciseVery people-oriented / follows people everywhereMouthy during play (common retriever behavior)None of the above

Does your dog seem more comfortable with a particular gender of people? *No preferencePrefers womenPrefers menNot sure

How does your dog usually greet new people entering the home? *Very friendly / excited / jumps upFriendly but calmShy at firstAvoids new peopleBarks or becomes protective

How does your dog respond if someone tries to take food, a bone, or a toy away? *Allows it easilyMoves away with the itemGrowls or stiffensSnaps or guards items

Has your dog ever growled at, snapped at, lunged at, attempted to bite, or bitten a person or another animal? *YesNo

If yes, please describe what happened (required)

Does your dog show signs of stress, nervousness, or anxiety in any of the following situations? *Check all that applyBeing left aloneWhen new people visit the homeLoud noises (thunder, fireworks, construction, etc.)Car ridesVet visits or groomingBusy or crowded environmentsWhen separated from their favorite personChanges in routine or environmentNone — my dog generally handles new situations well

If you checked any of the above, please briefly describe what your dog does (for example: pacing, whining, hiding, destructive behavior, barking, etc.):

What type of home do you feel would be best for your dog? (For example: another dog, fenced yard, active family, quiet home, etc.) *

Do you have any additional information that will help us match your dog to the best family?

I certify that the information provided on this form, including my dog’s behavioral and bite history, is complete and accurate to the best of my knowledge. I understand that any misrepresentation or omission may result in RAGofAZ declining to accept the dog for rehoming. *I have read and agree to the above statement.

Please upload a photo of your dog (less than 8 MB)

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Thank you for this information. We know this is a difficult decision, and we will do everything we can to make this as easy as possible. A RAGofAZ intake team member will contact you shortly.

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