Online Owner Surrender Form DHDR Owner Surrender FormOwner Surrender Questionnarie If you need to surrender your Doberman and have already visited our surrender process page, please fill out this information with as much detail as possible. We will then email you confirming receipt and will begin looking for a foster home that is a match. This can sometimes be immediate, and sometimes take weeks. We typically aim to find a foster match within a couple days. If you have any questions, please email us at contact@azdoberescue.org before filling out a surrender form. Legal *All boxes must be checked in order to proceed with the surrender form.I affirm that I am currently the sole and only legal owner of this dog and that I am legally entitled to transfer his/her ownership.I have carefully considered my decision to surrender this dog and affirm my belief that it is in the dog’s best interest to do so.I affirm that this surrender decision is made entirely voluntarily, without any outside influence whatsoever from any source including Desert Harbor Doberman Rescue of Arizona.I understand that by signing this form, I permanently surrender legal ownership of this dog to Desert Harbor Doberman Rescue of AZ.I/we understand that in order to allow this dog to bond successfully with a new family, I may have no future contact with him/her. Surrender QuestionnaireSurrendering Owners InformationDate * Owners Name * Owners Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Owners Phone Number * Owners Email Address * Owners Drivers License Number and Expiration Dogs InformationDogs Name * Approximate Date of Birth Dogs Approximate Age *Approximate age in weeks, months, or years. Breed * Alterations Cropped EarsDocked TailDew Claws RemovedDog Spayed / Neutered Dogs License Number Color *Black and RustRed and RustBlueFawnAlbino / WhiteOther Describe color * Is the dog microchipped? *YesNo Microchip Number How long have you had the dog? * If you found the dog as a stray, what have you done to find the owner? Why are you surrendering this dog? *Please provide as much detail and be as open as possible. Was the dog acquired from a breeder? *YesNo Do you have a signed contract with this breeder that requires you to return the dog if you can no longer care for him or her? *YesNo Do you affirm that you have contacted the breeder and asked them to take this dog back, and that the breeder declined to do so? *YesNo Is the dog AKC registered? *YesNo Is the registration being surrendered with the dog? *YesNo Is the pedigree being surrendered with the dog? *YesNo Veterinarian InformationAre the dogs medical records available? *Please contact your vet at the time of completing this form and ask that they send full records to contact@azdoberescue.org and also have them add a note to your file giving us approval for discussing/accessing the records. This will make it easier for us to take your dog.YesNo Practice Name * Veteranarian's Name * Veteranarian's Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Veteranaraian's Phone Number May we request the dog’s veterinarian to release the dog’s medical records to us? *YesNo Onwers initials and date *Please type your initials and date to authorize our request for records. Vaccination HistoryNotice Vaccination history is extremely important, as over-vaccinating dogs is highly dangerous. We will vaccinate again if we do not have a vaccination history. Date of last rabies vaccination Rabies vaccination duration 1 year3 yearUnknown Date of last Distemper/parvo/combo vaccine given Type of distemper/parvo vaccine DH2PPDH2PPL Date of last Bordatella vaccine Date of last Heartworm test Heartworm test result Date of last heartworm preventative given Date of last fecal worm check Worm results Disease, Injury, Surgery InformationHas this dog ever been diagnosed or treated for Valley Fever? *YesNoUnknown Is this dog von Willebrand’s affected? *YesNoUnknown Has this dog ever been diagnosed or treated for tick fever? *YesNoUnknown Has this dog ever been diagnosed or treated for Wobblers? *YesNoUnknown Has this dog ever been diagnosed or treated for dilated cardiomyopathy? *YesNoUnknown Besides those noted above, list all other medical conditions (allergies, diseases, wounds, breaks, abnormalities, illnesses, surgeries, pregnancies, and indicate all current concerns. Dogs Observed Behavior and TemperamentInstructions Your answers will help determine where we place this dog. To give him or her the best chance of a great forever home, please answer honestly and completely. For any of the following questions, use the comment box as needed. Please tell us about any temperament or behavior issues or concerns we should be aware of. Dog accepts / gets along well with Please check all boxes where you have personally observed the dog interacting with or getting along with the item/person/animal in the list. Only check boxes where the dog was comfortable and not displaying fear or hesitation around the item/person/animal described.Large male dogsSmall male dogsLarge female dogsSmall female dogsCatsMen (adult male)Women (adult female)Young children (0 - 10 years of age)Older children (10 - 18 years of age) Dog accepts / gets along well with (cont.) Please provide as much context as possible, especially around unchecked boxes (from previous question). Dogs social performance Please check all boxes where you have personally observed the dog interacting in the social situation listed. Only check boxes where the dog was comfortable and not displaying fear or hesitation in the situation described.Large crowds (5 or more persons)Small crowds (2 - 4 persons)Car ridesVeterinarians officePresence of large animals (horses, etc) Training Please check boxes where the dog has already been trained (or has received formal training if relevant).HousebrokenCrate trainedObedience trainedProtection trainedAgility trainedSchutzhund trainedRally trainedConfirmation trained Describe the dog Describe the dogs behavior, personality, and mannerisms in your own words with as much detail as possible. Describe the ideal home for this dog and why. Has the dog ever Please check boxes where the dog has either attempted or successfully performed any of the behaviors listed.Escaped the yardReturned when calledJumped or climbed fence/wallEaten inappropriate or inedible objectsChewed inappropriate or inedible objectsBarked excessivelyMarked inside home Has the dog ever bitten To the best of your knowledge, check any box where the dog has bitten or attempted to bite the animal/person described in the list.CatAnother dogAdult maleAdult femaleAdolescent maleAdolescent femaleMale childFemale childSkater or bicyclist Please describe any incident(s) of bite(s) *Please be as open and descriptive as possible. List any other behaviors / concerns Please describe any other behaviors or areas of concern with regard to the dog. Please be as open and descriptive as possible. Photo Upload Thank you for your information. Please upload any photos you are able to share here. If that is not possible, please email or text message them to azdoberescue@gmail.com. Text VerificationPlease enter any two digitsExample: 12This box is for spam protection - please leave it blank
