Golden Retriever Rescue of Mid-Florida, Inc
PO Box 1449, Goldenrod, FL 32733-1449
Voice Message Info Line: (407) 332-2840
Email: info@grrmf.org
 
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This form can be printed (use the select File, Print on your browser) and faxed toll free to 1-888-408-5520 or you can fill it out online and then press submit at the bottom of the form.
Email intake@grrmf.org if you have any questions.


    
Owner Surrender Form

We understand that giving up your pet may be a difficult decision, but we realize that in making this decision, you are thinking about your dog’s best interests. We are here to help. Please provide as much information as possible, so that we can find the appropriate home for your dog. Above all, please be honest. Your dog deserves a second chance to find the perfect home, and by providing us with the most detailed information, you will help GRRMF better accomplish this goal.

All questions must be answered--if not applicable or you don't know, enter N/A.

Surrendering owner's name:
Email Address:
Address:
City:
State:
Zip Code:
Phone #:
How often do you check email?
Dog Information
Dog's name:
Sex: Male
Female
Age:
Weight:
Color:
Is the dog spayed/neutered? Yes
No
Where did you get this dog?
How long have you had this dog?
Is it a purebred golden? Yes
No
I don't know
Do you have AKC papers? Yes
No
I don't know
Is the Pedigree available? Yes
No
I don't know
Are vacinations current? Yes
No
I don't know
If Yes, which vaccinations are current?
Veterinarian Name:
Veterinarian Address:
Is the dog on heartworm preventative? Yes
No
I don't know
If Yes, what brand of heartworm preventative?
What date was heartworm preventative last given?
Has this dog ever had a seizure? Yes
No
I don't know
If Yes, how often does the dog have seizures?
Does the dog have any ear problems? Yes
No
I don't know
List any orthopedic problems such as hip dysplasia, arthritis, stiffness or difficulty moving around:
Condition of skin - any allergies? Yes
No
I don't know
Please list any other medical conditions:
Behavior Assessment
What is the dog's disposition?
Is the dog confident or shy?
Can you take food away? Yes
No
I don't know
Can you take toys away? Yes
No
I don't know
Can you take bones away? Yes
No
I don't know
Does the dog dig? Yes
No
I don't know
Does the dog chew? Yes
No
I don't know
Does the dog escape from the yard or house? Yes
No
I don't know
Does the dog run away? Yes
No
I don't know
Does the dog jump fences? Yes
No
I don't know
Does the dog jump on people? Yes
No
I don't know
Does the dog steal food or items from the counters or tables? Yes
No
I don't know
Does the dog swim? Yes
No
I don't know
Does the dog ride well in cars? Yes
No
I don't know
Is the dog afraid of thunderstorms? Yes
No
I don't know
If yes, what does this dog do during a thunderstorm?
Is this an inside or outside dog? Inside
Outside
Is the dog housebroken? Yes
No
I don't know
Is the dog crate trained? Yes
No
I don't know
Does the dog get along with Children: Yes
No
Does the dog get along with other dogs? Yes
No
Does the dog get along with cats? Yes
No
Does the dog get along with other animals? Yes
No
Is this dog aggressive to other dogs? Yes
No
If Yes, what did the dog do to make you think it didn't like the other dog?
Is the dog possessive over the food dish? Yes
No
I don't know
Has the dog ever lived with children? Yes
No
If Yes, for how long?
What were the children's ages?
How did the children treat the dog?
Does the dog accept strangers? Yes
No
Does the dog accept men? Yes
No
Does the dog accept women? Yes
No
Is there anywhere the dog does not like to be touched? Yes
No
Has the dog ever growled or bit a person? Yes
No
Has the dog ever growled at or bit another animal such as a dog or cat? Yes
No
Has the dog ever displayed any other signs of aggression? Please describe below or enter N/A:
Does the dog like to grab your arm or clothes (mouthy)? Yes
No
If Yes, please explain:
Does the dog like to chase bikes or cars? Yes
No
I don't know
What does the dog dislike?
What is the dog afraid of?
Has the dog been to obedience school? Yes
No
If Yes, which obedience school?
Does the dog know any commands? Please list:
What are your training methods? Please describe:
Have you ever disciplined this dog when he/she has done something wrong? Please describe:
Home Environment Assessment
Has the dog ever lived with other dogs? Yes
No
Has the dog ever lived with cats? Yes
No
How do you exercise the dog?
Is this dog used to being home alone during the day? Yes
No
If Yes, how many hours on average?
Does the dog have separation anxiety? Yes
No
What kind of food is the dog eating now?
Is the dog on any vitamins or supplements? Please list:
Additional Comments
Why are you giving up this dog? (Please be as detailed as possible.)
What are the areas in which your dog may need more guidance or training?
Please tell us the best things about your dog.

Please note: Please note that GRRMF does not buy or pay for dogs. This is a service to help place your golden retriever in a new home. We do appreciate donations to help us with expenses we incurr.

Next Steps:
Please read through the form again to ensure you have been as thorough as possible! It will improve your dog’s chance to find a new home. Once the form is submitted a volunteer will be in contact with you to discuss any questions you may have about our process or that we have about your dog.

GRRMF is an all-volunteer organization, so we ask for your patience. We are all volunteers and have full time jobs, please be patient. If we can not admit your dog into our program, we will be in contact within 48 hours. If we have room in our program, arrangements will be made for you to drop off your dog or for a volunteer to meet you.

We ask that you bring copies of any all veterinary records and any other necessary paperwork at the time you release the dog into our care. Please note that summer months and holiday periods are our busiest times. To expedite the process, you can e-mail photos of your dog to intake@grrmf.org. Please include the dog’s name in the subject line and your name in the body of the e-mail. The photo is only to verify that your dog is, in fact, a golden retriever and will help streamline this process.