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Established in 2000
Over 1,100 Goldens Rescued
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Surrender
G.R.E.A.T. Rescue of NE Florida, Inc.
Owner Surrender Agreement
Please enable JavaScript in your browser to complete this form.
Surrender Form - Contact Information
-
Step
1
of 6
Contact Information
Please fill out all entries. Fields marked with an asterisk (*) are required.
Name of Applicant
*
First
Last
Name of Owner
*
First
Last
Owner's Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Owner’s Home Phone
Owner’s Work Phone
Owner’s Cell Phone
Owner's Email
*
Email
Confirm Email
Is there a co-owner?
*
Yes
No
Name of Co-Owner
*
First
Last
Co-Owner's Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Co-Owner’s Home Phone
Co-Owner’s Work Phone
Co-Owner’s Cell Phone
Co-Owner’s Email Address
*
Email
Confirm Email
Next
Golden's Information
Name of Golden
*
Age of Golden
*
Origin of Ownership
*
Length of Ownership
*
Purebred?
*
Yes
No
What is the breed mix?
*
Sex of Golden
*
Male
Female
Neutered?
*
Yes
No
Spayed?
*
Yes
No
Weight
*
Color
*
Does the golden have a microchip?
Yes
No
Microchip Number
Microchip Company
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Next
Golden's Medical Information
Name of Veterinary
*
Veterinary's Phone Number
*
Any Veterinary Specialist(s) seen?
*
Yes
No
Name 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.?
*
Yes
No
Don't know
Please explain medical problems.
*
Is the dog on any medications, supplements, etc.?
*
Yes
No
Don't know
Please list medications, supplements, etc.
*
Brand of Dog Food
*
Amount of Dog Food Given and How Often
*
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Next
Golden's Social/Behavioral
Has the dog bitten a person?
*
Yes
No
Don't know
Please describe circumstances of the biting incident.
*
Has the dog bitten an animal such as a cat or dog?
*
Yes
No
Don't know
Please describe circumstances of the biting incident.
*
Do you own other pets?
*
Yes
No
Please describe animal(s), breeds and ages.
*
Does the dog get along with female dogs?
*
Yes
No
Don't know
Does the dog get along with male dogs?
*
Yes
No
Don't know
Does the dog get along with cats?
*
Yes
No
Don't know
Is the dog people/toy possessive?
*
Yes
No
Don't know
Comments on people/toy possessiveness.
*
Is the dog food aggressive?
*
Yes
No
Don't know
Comments on food aggression.
*
Is the dog storm phobic?
*
Yes
No
Don't know
Comments on storm phobia.
*
Is the dog afraid of loud noises such as fireworks?
*
Yes
No
Don't know
Comments on loud noises.
*
Is the dog crate trained?
*
Yes
No
Don't know
Is the dog house broken?
*
Yes
No
Don't know
Comments on house broken.
*
Is the dog accustomed to being alone?
*
Yes
No
Don't know
For how long is the dog left alone?
*
Comments on not accustomed to being alone.
*
Is your dog destructive when alone?
*
Yes
No
Don't know
Please describe circumstances.
*
Does the dog dig?
*
Yes
No
Don't know
Comments on digging.
*
Does the dog jump or climb fences?
*
Yes
No
Don't know
Comments on jumping/climbing fences.
*
Does the dog prefer men or women?
*
Men
Women
No preference
Don't know
Name special activities, foods, etc. this Golden enjoys.
*
What does this Golden dislike/fear?
*
Has this dog had obedience training?
*
Yes
No
Don't know
Where did the dog have obedience training?
*
Does your dog know basic commands?
*
Yes
No
Don't know
What commands are known?
*
Do you have children?
*
Yes
No
What are the children's ages?
*
Previous
Next
Release Information
What is the reason for releasing this Golden?
*
Can the Golden remain in your home until a suitable foster home has been committed?
*
Yes
No
Maybe
How 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?
*
Yes
No
What 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)?
*
Yes
No
Please explain dispute.
*
Any other comments?
How did you hear about GREAT?
Photograph of Golden
Please 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.
Click or drag a file to this area to upload.
Previous
Next
Terms of Surrender
Thank 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
*
First
Last
Name of Co-Surrenderer
*
First
Last
Surrender 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
*
Date
Time
Submission Notes
A 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.
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