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Surrender Form

Home » Surrender Form

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

Date

First Name *

Last Name *

Email Address *

Additional email

Street Address *

City

State/Province

ZIP / Postal Code

Preferred Phone Number - list as home/cell/work *

Additional phone number

Are you the current owner? *YesNo

Is there a co-owner? 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)?

Gender *

What color is your dog? *

How much does your dog weigh? *

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?

Present health of your dog? List any medical issues and current medications. *

Is your dog spayed or neutered? *

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

List their current veterinarian contact information. *

Is your dog microchipped? *

Are your dog's vaccinations up to date? Rabies / others *

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

Is your dog housebroken (potty trained)? *

Can your dog use a dog door? *

Is your dog crate trained? *

Where is your dog during the day (Free run of the house/crated/outside/other)? *

Where is your dog during the night (Free run of the house/crated/outside/other)? *

How active is your dog?

Very activeActiveCalmPuppy-like

What is your dog's temperament?

LovingFriendlyAnxious or NervousShyExcitableSubmissiveAlphaPuppy-likeMellow

Does your dog go shopping for food on the kitchen counter? *

Does your dog like to dig? *

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

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

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

Does your dog do alert or more frequent barking? *

How does your dog respond to loud noises, thunder, fireworks? *

Does your dog like to swim? *

What other animals has your dog lived with? (Cats, other dogs, list breed) *

Does your dog ride well in a car? *

Does your dog get car sick? *

Has your dog been to a dog park? *

How does your dog interact with other dogs? *

Will your dog playfully mount other dogs? *

How does your dog greet new people? *

What age of adults/kids has your dog been exposed to? *

Does your dog like kids? *

Is your dog gentle or rough with small kids? *

How easy is it to take food, bones or toys from your dog's mouth? If not easy, how does your dog let you know it's not ok? *

Has your dog ever attacked or bitten a person or another animal? *

Owner will be asked to sign a Surrender form stating the dog has no history of biting or showing aggressive behavior of any kind or will be returned to the owner. *

I have read the above statement and agree to the terms and conditions.

Does your dog walk with a collar, gentle leader, harness, chain collar or other? *

Does your dog want to be the leader of the pack and pull when walking? *

Does your dog know any commands the new family should know (Sit/Stay/Wait/Leave it/Down)?

SitStayWaitLeave itDown

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

I hereby declare that all the information provided by me in this document is factual and correct to the best of my knowledge and belief. I understand that any misrepresentation or omission discovered may result in the dog not being accepted for rehoming by Rescue A Golden of Arizona. *

I have read the above statement and agree to the terms and conditions.

2550 E. Rose Garden Lane # 71987
Phoenix, AZ 85050*

602.404.WOOF (9663) or TEXT 267.538.0433

*location of our post office box only; not a RAGofAZ office

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