<p> Owner Relinquishment Contract</p><p>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.</p><p>Owner Information</p><p>Owner Name (please print) ______</p><p>Street Address ______</p><p>City ______State ______Zip Code ______</p><p>Home Phone ______Cell Phone ______E-Mail ______</p><p>Dog Information</p><p>Dog’s Name ______Color (circle one): Silver Blue Dog’s Weight ______</p><p>Age ______Birthdate (if known) ______Sex of Dog (circle one): Female Male </p><p>Is the dog Spayed or Neutered (circle one)? Yes No If yes, can you provide proof (vet certificate, invoice)? Yes No</p><p>Is your dog microchipped or tattoed? Yes No If yes, what is the ID# ______</p><p>Company where chip is registered (24-Petwatch, Avid, Home Again, etc.) ______</p><p>How long have you owned this Weimaraner? ______</p><p>Please state the reason for giving up your Weimaraner______</p><p>______</p><p>Is your dog’s move time-sensitive? Yes No If yes, why? ______</p><p>Please list any other organizations you have contacted regarding re-homing your dog (so we don’t duplicate efforts). ______</p><p>Legal Transfer of Ownership</p><p>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. </p><p>Signature ______Date ______Dog Detail</p><p>Dog’s Name ______Sex of Dog (circle one): Female Male Dog’s Age ______</p><p>How did you acquire this dog (breeder, shelter, friend, pet store, stray, etc.) ______</p><p>If obtained from a breeder, does your contract have a return clause? Yes No</p><p>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.</p><p>Please give us some general information about the dog and its behaviors. Is he or she:</p><p>Housebroken? Yes (has not relieved themselves in the home for at least three months) No</p><p>If yes, how does your dog signal to go outside? ______</p><p>Crate trained? Yes No If yes, what type of crate? Metal Plastic Do they destroy bedding in crate? Yes No</p><p>When no one is home, the dog is (circle one): Indoors free roaming Indoors in a crate Kept outdoors</p><p>How long is your dog typically left alone during the day? ______</p><p>Good with children under five years old? Yes No</p><p>Please list ages of all people currently living with the dog ______</p><p>Good with other dogs? Yes No Don’t know Good with cats? Yes No Don’t know</p><p>Good with any other types of animals? Yes No Don’t know </p><p>Please list all other pets (species, breed, age and sex) presently in the house ______</p><p>______</p><p>______</p><p>Trained or used as a hunting dog? Yes No The dog is kept primarily (circle one): Indoors Outdoors</p><p>Has your dog shown any aggression (people, dog, toy or food) issues? Yes No</p><p>If yes, please describe the incident(s) as clearly as possible ______</p><p>______</p><p>______</p><p>Has your dog EVER bitten anyone? Yes No If yes, how severely? ______</p><p>Does your dog guard toys, food, beds, etc.? ______</p><p>How does he/she react when approached if guarding the above? ______</p><p>How does your dog greet visitors to your home? ______Does your dog have issues with barking? Yes No If yes, how have you corrected? ______</p><p>______</p><p>Does the dog chew on household items? Yes No</p><p>What are your dog’s favorite toys and activities? ______</p><p>______</p><p>Where does your dog sleep at night? ______</p><p>Does your dog require physical containment when outside (fence, tie out, kennel enclosure, etc.)? Yes No</p><p>If yes, what type of containment area do you currently use? ______</p><p>Does your dog jump fences? Yes No If yes, how high was the fence? ______</p><p>Is your dog trained on an invisible fence? Yes No</p><p>How does your dog behave on car rides? ______</p><p>Has your dog attended obedience training? Yes No If yes, when and what type? ______</p><p>______</p><p>Is the dog leash trained and easy to walk? Yes No What type of collar is used to walk? ______</p><p>Is your dog reliable off-leash? Yes No Does your dog enjoy swimming? Yes No Don’t know</p><p>How much exercise does your dog get on a weekly basis? ______</p><p>Do you take your dog to dog parks? Yes No </p><p>What brand/type of food does your dog eat? ______</p><p>How many times a day does your dog eat (and when)?______</p><p>How much food do you feed each meal? ______</p><p>Where is your dog kept when you go on vacation? ______</p><p>What type of home would you say would suit your dog best? ______</p><p>______</p><p>______</p><p>Please give any other comments that will help us place the dog in the best home possible. ______</p><p>______</p><p>______Dog Health Information</p><p>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.</p><p>Clinic or Veterinarian’s Name ______</p><p>Address ______</p><p>Phone Number ( )______Do you give permission to GLWR to contact your </p><p>Veterinarian for historical medical information on your dog? If yes, please initial here ______</p><p>Please note which of the following immunizations or medical check ups your dog has had and when:</p><p>Rabies Vaccine Yes or No Date Given _____/_____/_____ 1-year or 3-year? (circle one)</p><p>Distemper Vaccine Yes or No Date Given _____/_____/_____ 1-year or 3-year? (circle one)</p><p>Bordetella Vaccine Yes or No Date Given _____/_____/_____</p><p>De-worming Yes or No Date Given _____/_____/_____</p><p>Heartworm Test Yes or No Date Given _____/_____/_____</p><p>Heartworm Test results were: Negative Positive If positive, was dog successfully treated? Yes No</p><p>Date Heartworm Prevention was last given _____/_____/_____</p><p>Lyme Test results (if any) were: Negative Positive If positive, was dog successfully treated? Yes No </p><p>Ehrlichia Test results (if any) were: Negative Positive If positive, was dog successfully treated? Yes No </p><p>Is your Weimaraner currently taking any medication? If so what type and why? ______</p><p>______</p><p>______</p><p>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? </p><p>Please explain: ______</p><p>______</p><p>How did you learn about Great Lakes Weimaraner Rescue? ______</p><p>Please note: GLWR is a non-profit rescue. Any donation toward your dog’s care would greatly be greatly appreciated.</p>