Mid-Atlantic German Shorthaired Pointer Rescue Surrender Form

To submit your information, please fill in the form below as completely as possible. All fields marked with an * are required fields. After clicking the SUBMIT button, if there are any errors or missed fields, the errors will display with a RED error message next to the problem field. You will then have the opportunity to enter any missing data or fix any errors. All errors or incomplete fields must be entered before your information can be submitted. Upon successfully submitting all information, you will see a confirmation message.

Applicant

First Name
Last Name
Street
City
State
Zipcode
Home Phone
Cell Phone
Email

Your Vet

Vet Name
Vet Telephone
Vet Street Address
Vet City
Vet State
Vet Zipcode

Dogs Name
Gender
Is The Dog Altered
YesNo
Dogs Age
Akc Or Microchip Number
Color
Is The Dog Housetrained
YesNo
Is The Dog Crate Trained
YesNo
Any Physical Problems Please Explain
Date Of Most Recent Vaccines
Is Dog On Heartworm Preventative
YesNo
How Is Dog With Other Dogs
How Is Dog With Children
How Is Dog With Stranger
How Is Dog With Cats
How Is Dog Walking On Lead
How Is Dog If Left Along In Fenced Yard
How Is Dog If Left Alone In The House
How Is Dog If Left Alone In The Car
What Does Your Dog Like Best
What Does Your Dog Dislike
What Does Your Dog Fear
How Does Your Dog Act When Fearful
Has Your Dog Ever Bitten Anyone
YesNo
Has Your Dog Ever Bitten Another Dog
YesNo
Where Has Your Dog Slept
Where Has Your Dog Spent The Day
What Brand Dogfood Does Your Dog Eat
How Much And How Often Do You Feed Your Dog
Has Your Dog Had Any Training And By Whom
List Commands Your Dog Knows
What Would Describe Are Your Dogs Bad Habits
Why Are You Surrendering Your Dog
Describe Ideal Home For Your Dog
Name Address And Phone Of Breeder If Known
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