GLWR Relinquishment Form

Owner Relinquishment Contract

Thank you for taking the time to thoroughly fill out this form. The information provided by you is important and allows Great Lakes Weimaraner Rescue to make the best possible decision when re-homing your Weimaraner.

Owner Information

Owner Name (please print) ______

Street Address ______

City ______State ______Zip Code ______

Home Phone ______Cell Phone ______E-Mail ______

Dog Information

Dog’s Name ______Color (circle one): Silver Blue Dog’s Weight ______

Age ______Birthdate (if known) ______Sex of Dog (circle one): Female Male

Is the dog Spayed or Neutered (circle one)? Yes No If yes, can you provide proof (vet certificate, invoice)? Yes No

Is your dog microchipped or tattoed? Yes No If yes, what is the ID# ______

Company where chip is registered (24-Petwatch, Avid, Home Again, etc.) ______

How long have you owned this Weimaraner? ______

Please state the reason for giving up your Weimaraner______

______

Is your dog’s move time-sensitive? Yes No If yes, why? ______

Please list any other organizations you have contacted regarding re-homing your dog (so we don’t duplicate efforts). ______

Legal Transfer of Ownership

I understand that by completing this form and signing it that I am legally surrendering this animal to the care and control of Great Lakes Weimaraner Rescue, Inc. I certify that I am the legal owner of this Weimaraner and I give up all legal rights and interest in the animal listed above to Great Lakes Weimaraner Rescue, Inc. A non-profit 501(c)(3) organization.

Signature ______Date ______Dog Detail

Dog’s Name ______Sex of Dog (circle one): Female Male Dog’s Age ______

How did you acquire this dog (breeder, shelter, friend, pet store, stray, etc.) ______

If obtained from a breeder, does your contract have a return clause? Yes No

If obtained from a breeder, have you informed them you can no longer keep the dog? Yes No If no, please contact your breeder, as reputable breeders will want the right of first refusal.

Please give us some general information about the dog and its behaviors. Is he or she:

Housebroken? Yes (has not relieved themselves in the home for at least three months) No

If yes, how does your dog signal to go outside? ______

Crate trained? Yes No If yes, what type of crate? Metal Plastic Do they destroy bedding in crate? Yes No

When no one is home, the dog is (circle one): Indoors free roaming Indoors in a crate Kept outdoors

How long is your dog typically left alone during the day? ______

Good with children under five years old? Yes No

Please list ages of all people currently living with the dog ______

Good with other dogs? Yes No Don’t know Good with cats? Yes No Don’t know

Good with any other types of animals? Yes No Don’t know

Please list all other pets (species, breed, age and sex) presently in the house ______

______

Trained or used as a hunting dog? Yes No The dog is kept primarily (circle one): Indoors Outdoors

Has your dog shown any aggression (people, dog, toy or food) issues? Yes No

If yes, please describe the incident(s) as clearly as possible ______

______

Has your dog EVER bitten anyone? Yes No If yes, how severely? ______

Does your dog guard toys, food, beds, etc.? ______

How does he/she react when approached if guarding the above? ______

How does your dog greet visitors to your home? ______Does your dog have issues with barking? Yes No If yes, how have you corrected? ______

______

Does the dog chew on household items? Yes No

What are your dog’s favorite toys and activities? ______

______

Where does your dog sleep at night? ______

Does your dog require physical containment when outside (fence, tie out, kennel enclosure, etc.)? Yes No

If yes, what type of containment area do you currently use? ______

Does your dog jump fences? Yes No If yes, how high was the fence? ______

Is your dog trained on an invisible fence? Yes No

How does your dog behave on car rides? ______

Has your dog attended obedience training? Yes No If yes, when and what type? ______

______

Is the dog leash trained and easy to walk? Yes No What type of collar is used to walk? ______

Is your dog reliable off-leash? Yes No Does your dog enjoy swimming? Yes No Don’t know

How much exercise does your dog get on a weekly basis? ______

Do you take your dog to dog parks? Yes No

What brand/type of food does your dog eat? ______

How many times a day does your dog eat (and when)?______

How much food do you feed each meal? ______

Where is your dog kept when you go on vacation? ______

What type of home would you say would suit your dog best? ______

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Please give any other comments that will help us place the dog in the best home possible. ______

______

______Dog Health Information

Please provide us your dog’s current medical information. Please include copies of any and all records (veterinary records, AKC papers, etc.) that you may have.

Clinic or Veterinarian’s Name ______

Address ______

Phone Number ( )______Do you give permission to GLWR to contact your

Veterinarian for historical medical information on your dog? If yes, please initial here ______

Please note which of the following immunizations or medical check ups your dog has had and when:

Rabies Vaccine Yes or No Date Given _____/_____/_____ 1-year or 3-year? (circle one)

Distemper Vaccine Yes or No Date Given _____/_____/_____ 1-year or 3-year? (circle one)

Bordetella Vaccine Yes or No Date Given _____/_____/_____

De-worming Yes or No Date Given _____/_____/_____

Heartworm Test Yes or No Date Given _____/_____/_____

Heartworm Test results were: Negative Positive If positive, was dog successfully treated? Yes No

Date Heartworm Prevention was last given _____/_____/_____

Lyme Test results (if any) were: Negative Positive If positive, was dog successfully treated? Yes No

Ehrlichia Test results (if any) were: Negative Positive If positive, was dog successfully treated? Yes No

Is your Weimaraner currently taking any medication? If so what type and why? ______

______

Does your dog have any other medical condition or is there any other medical information that would be helpful for GLWR to know? Allergies? Food sensitivities? Exercise limitations? Past accidents? Broken bones? Surgeries?

Please explain: ______

______

How did you learn about Great Lakes Weimaraner Rescue? ______

Please note: GLWR is a non-profit rescue. Any donation toward your dog’s care would greatly be greatly appreciated.