Surrender Form G.R.E.A.T. Rescue of NE Florida, Inc. Owner Surrender Agreement Please enable JavaScript in your browser to complete this form.Name of Applicant *FirstLastName of Owner *FirstLastOwner's Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeOwner’s Home PhoneOwner’s Work PhoneOwner’s Cell Phone Owner's Email *EmailConfirm EmailIs there a co-owner? *YesNoName of Co-Owner *FirstLastCo-Owner's Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCo-Owner’s Home PhoneCo-Owner’s Work PhoneCo-Owner’s Cell PhoneCo-Owner’s Email Address *EmailConfirm EmailGolden's InformationName of Golden *Age of Golden *Origin of Ownership *Length of Ownership *Purebred? *YesNoWhat is the breed mix? *Sex of Golden *MaleFemaleNeutered? *YesNoSpayed? *YesNoWeight *Color *Microchip NumberMicrochip CompanyMedical InformationName of Veterinary *Veterinary's Phone Number *Any Veterinary Specialist(s) seen? *YesNoName of Veterinary Specialist *Veterinary Specialist's Phone Number *Purpose of Specialist? *If more than one specialist seen, please give details below including specialist name, phone number and purpose.Date of Last Rabies Vaccination *Date of Last DHPP Vaccination *Date of Last Bordetello Vaccination *Date of Last Heart Worm Check *Brand of Heart Worm Prevention Given *Date Last Heart Worm Preventative Given *Brand of Flea Prevention Given *Date Last Flea Prevention Given *Any medical problems such as allergies, frequent ear infections, dental, fur loss, skin infections, etc.? *YesNoDon't knowPlease explain medical problems. *Is the dog on any medications, supplements, etc.? *YesNoDon't knowPlease list medications, supplements, etc. *Brand of Dog Food *Amount of Dog Food Given and How Often *Social/BehavioralHas the dog bitten a person? *YesNoDon't knowPlease describe circumstances of the biting incident. *Has the dog bitten an animal such as a cat or dog? *YesNoDon't knowPlease describe circumstances of the biting incident. *Do you own other pets? *YesNoPlease describe animal(s), breeds and ages. *Does the dog get along with female dogs? *YesNoDon't knowDoes the dog get along with male dogs? *YesNoDon't knowDoes the dog get along with cats? *YesNoDon't knowIs the dog people/toy possessive? *YesNoDon't knowComments on people/toy possessiveness. *Is the dog food aggressive? *YesNoDon't knowComments on food aggression. *Is the dog storm phobic? *YesNoDon't knowComments on storm phobia. *Is the dog afraid of loud noises such as fireworks? *YesNoDon't knowComments on loud noises. *Is the dog crate trained? *YesNoDon't knowIs the dog house broken? *YesNoDon't knowComments on house broken. *Is the dog accustomed to being alone? *YesNoDon't knowFor how long is the dog left alone? *Comments on not accustomed to being alone. *Is your dog destructive when alone? *YesNoDon't knowPlease describe circumstances. *Does the dog dig? *YesNoDon't knowComments on digging. *Does the dog jump or climb fences? *YesNoDon't knowComments on jumping/climbing fences. *Does the dog prefer men or women? *MenWomenNo preferenceDon't knowName special activities, foods, etc. this Golden enjoys. *What does this Golden dislike/fear? *Has this dog had obedience training? *YesNoDon't knowWhere did the dog have obedience training? *Does your dog know basic commands? *YesNoDon't knowWhat commands are known? *Do you have children? *YesNoWhat are the children's ages? *Release InformationWhat is the reason for releasing this Golden? *Can the Golden remain in your home until a suitable foster home has been committed? *YesNoMaybeHow long can the Golden remain in your home? *Comments on no or maybe staying in your home. *Are you working with any other source to place this Golden? *YesNoWhat other sources? *Are there any known disputes regarding your current ownership of this Golden (i.e. Is there anyone else who might have claim to this dog)? *YesNoPlease explain dispute. *Any other comments?How did you hear about GREAT?Photograph of GoldenPlease upload a picture of the Golden Retriever to be surrendered. You will also need to provide the Veterinary Records if this dog is selected to come into GREAT Rescue.Terms of SurrenderThank you for the confidence you have placed in GREAT Rescue of NE Florida Inc, also known as GREAT and GREAT Rescue by allowing us to re-home your beloved Golden Retriever. We understand this is a difficult decision and we assure you that we will do our best to find a wonderful, loving and responsible home for him/her. Please understand that this surrender is irrevocable and once your Golden Retriever is surrendered, GREAT will hold the title to your Golden Retriever and GREAT will have the sole right and authority to make all decisions regarding your Golden Retriever. Once surrendered, your Golden Retriever will not be returned.Name of Surrenderer *FirstLastName of Co-Surrenderer *FirstLastSurrender Agreement * I/We Acknowledge and Agree.I/we acknowledge that I/we have read and answered the above questions to the best of my/our ability, confirm that this Golden Retriever is owned by me/us and will abide by the terms of this surrender. I/we understand this surrender is irrevocable and I hereby renounce any and all claims to the above described Golden Retriever. It is my understanding that G.R.E.A.T. Rescue of NE Florida, Inc. and those who volunteer on its behalf are in no way liable whatsoever in any regard now or hereafter concerning the surrender of this Golden Retriever.Date / Time of Submission *DateTimeCaptcha * = Submission NotesA CONFIRMATION PAGE WILL APPEAR UPON SUCCESSFUL SUBMISSION. IF AFTER CLICKING SUBMIT, ONE OR MORE ERRORS ARE FOUND, THE PAGE WILL SCROLL UP TO THE FIRST ERROR AND THE ERROR MESSAGE "This field is required." WILL APPEAR. PLEASE CORRECT ANY ERRORS AND SUBMIT AGAIN. IF YOU STILL HAVE PROBLEMS, PLEASE SEND AN EMAIL TO info@greatrescue.org TO REQUEST AN ELECTRONIC VERSION OF THE FORM.CommentSubmit