Surrender Information Request | National Great Pyrenees Rescue

First Name: *

Last Name: *

Address: *

City: *

State/Province: *

Zip: *

Phone (1): *

Phone (2):

E-mail Address: *

How Did You Hear About Us:

Dog's Name:

Dog's Sex:

Dog's Age:

Does the Dog Have AKC Papers:

Yes

No

Is the Dog Spayed/Neutered:

Yes

No

Dog's Color and Markings. Please tell us if the dog has double dew claws:

Where Did You Obtain the Dog? (List Breeder/Pet Store, Shelter, or Prior Owner, Town):

How Much Did the Dog Cost? (If Applicable):

How Long Have You Had the Dog:

Your Reason(s) for Surrendering the Dog:

We understand that no dog is perfect. Please answer the following questions as honestly and accurately as possible so that we may better help in placing the dog in the best possible environment. Incomplete forms will not be accepted.

Is the Dog a:

House Dog

Outdoor Dog

Where Does the Dog Spend the Majority of Its Time:

Where Does the Dog Sleep:

Will the Dog Run If Loose:

Yes

No

Has the Dog Ever Escaped or Jumped a Fence:

Yes

No

Is the Dog Crate-trained:

Yes

No

Is the Dog House-trained:

Yes

No

Will the Dog Walk On a Leash Quietly:

Yes

No

Will the Dog Come When Called:

Yes

No

Does the Dog Get Along Safely with Cats:

Yes

No

Unsure

Does the Dog Get Along Safely with Other Dogs:

Yes

No

Unsure

Does the Dog Get Along Safely with Children:

Yes

No

Unsure

Does the Dog Get Along Safely with Strangers:

Yes

No

Unsure

Is the Dog Bothered by the Presence of Others (Animals or People) While Eating:

Yes

No

What Is the Dog Fed? (Please Indicate Type of Food and Brand Name, e.g., Purina ONE, Pedigree Large Breed, etc.):

Would You Describe the Dog As:

Sedentary

Active

Is the Dog Destructive in the Home:

Yes

No

If You Answered "Yes" to the Above Question, Please Explain:

Does the Dog Become Anxious When Left Alone:

Yes

No

If You Answered "Yes" to the Above Question, Please Describe Your Dog's Anxiety:

Is There Any History of Aggressive Behavior Against People or Animals:

Yes

No

If You Answered "Yes" to the Above Question, Please Describe the Aggressive Behavior:

Please Tell Us Everything You Can About the Dog's History, Personality, Quirks, etc:

Does the Dog Have Arthritis:

Yes

No

Does the Dog Have Diabetes:

Yes

No

Does the Dog Have Hip or Leg Problems:

Yes

No

Does the Dog Have Other Health Problems:

Yes

No

If You Answered "Yes" to the Above Question, Please Explain:

Please answer the questions below to the best of your ability. If you don't know the date of a vaccination or test, simply say "unsure" or "don't know".

Date of Last DHLP Vaccination:

Date of Last Rabies Vaccination:

Date of Last Bordetella Vaccination:

Date Heartworm Preventative Was Administered, or Date of Last Heartworm Test:

Date of Last Fecal Exam for Worms:

Veterinarian's Name:

Veterinarian's Phone Number:

Your Household

Number of People in Household:

Ages of Children:

Do You Currently Own Other Dogs:

Yes

No

If You Answered "Yes" to the Above Question, Please List Age, Sex and Whether Spayed/Neutered:

Do You Currently Own Other Pets:

Yes

No

If You Answered "Yes" to the Above Question, Please List Type, Sex and Age:

How Long Can You Hold the Dog You Want to Surrender:

Will You Help Transport Him or Her:

Yes

No

Please contact your vet and authorize him or her to release information to National Pyr Rescue. You must follow this application with a digital photo of the dog (by email) to info@nationalpyr.org.

Processing of dogs without digital photographs will be delayed until a photo is received. If in the event there is no other option, photos can be mailed to the address below.
Again, please note that this is not a Transfer of Ownership form. That form will be provided at the time of the dog's surrender. At that time, you will also need to supply vet records and AKC papers, if any.
Use the "Submit" button below to submit your completed form online.
To mail or fax a completed form, use the address information below.

National Great Pyrenees Rescue, P.O. Box 214, Maplecrest, NY 12454-5200. Email: info@nationalpyr.org. Fax: 518-734-5486.