Coastal German Shepherd Rescue

Owner Surrender
Questionnaire

Please answer the questions honestly and be as detailed as possible. This will help is in determining if we will be able to accept your dog in to our rescue.

Please note that shelter dogs in need will take precedence over any owner surrendered dog. Due to the lack of foster home, in most cases, you will be required to "foster" your dog until a home can be found.

This information MUST be submitted along with a photograph before we will consider accepting your dog in to our program. Upon completing the below information, IMMEDIATELY email a picture of your dog to baltao@sbcglobal.net. No further action is required. As a 100% volunteer organization, we will contact you as soon as possible, usually within 48 hours.

Owner Information

* denotes a required field

Name: *

Address: *

City: *

State: *

Zip Code: *

E-mail: *

Phone: *

Evening Phone Number:

Mobile Phone Number:

Best time to contact you:

Dog Information

Dog's Name:

AKC Name:

AKC Number:

Date of Birth:

How Originally Acquired Dog:

When Acquired:

If from a Breeder, have you contacted them?

Why do you need to rehome your German Shepherd?

When does dog have to leave your home?

Are you willing to foster the dog after legally relinquishing the dog to us until a permanent home can be found?

Dog’s Physical Appearance

Sex:

Age:

Color:

Height: Weight:

Tattoo:

Micro Chip (Make & Number):

Scars, Broken Teeth, etc.:

General overall appearance:

Personality Traits
(please check all that apply)

Likes

Dogs Cats Other Small Animals Children Strangers Visits to Vet:

Crates Car Rides Toys/Play Water Being Groomed Traveling

Running/Jogging Likes Walks

Dislikes/Habits

Dog Aggression Food Aggression Toy Aggression Fence Jumping Escapes Yard

Digging Separation Anxiety Chewing Barking when left unattended Destructive

Scared of Thunderstorms

Other Fears/Dislikes:

Other Aggressions:

Temperament Toward People

Friendly Shy Cautious Outgoing Hyper Energetic Calm

Anxious Dominant Submissive Submissive Peeing Obedient Challenging

Temperament Towards Other Dogs

Friendly Shy Cautious Outgoing Hyper Energetic Calm

Anxious DominantSubmissive Obedient Challenging

Has dog ever bitten a human? If yes describe situation, location, when, seriousness of bite, etc.

Has dog ever nipped/shown aggression towards a human? If yes describe situation, location, when, etc.

Types of Training this dog has had:

Is the dog crate trained:

Describe any behavioral problems you have experienced.

I would consider this dog to have a energy level.

Dog’s History and Experiences

House dog Housebroken Outdoor Dog Tied Up Contained in Open Yard

Sleeps Inside Sleeps Outside Sleeps in the Garage

Has this dog ever been:

Abused Neglected in any way Hit by a car Bred Allowed on Furniture

Allowed to run off-leash in a NON-fenced in area Attacked by another animal

Kenneled Used to wearing a collar

How does this dog signal to go outside:

What words or commands does this dog know:

Medical History

We request you provide Coastal GSR with copies of the dog’s entire medical history file if possible when your dog is accepted in to our care.

Veterinarian Name:

Address:

City, State, Zip:

Phone:

Date of Last Visit for this dog:

Vaccination History
(dates last received)

We encourage owners to have their dog current on all vaccines, be spayed/neutered PRIOR to acceptance.

DHPP: Rabies: Bordetella:

Date of HEARTWORM Test: Results:

Currently on Preventative: What Brand:

IS THIS DOG IS SPAYED/NEUTERED?

Allergies:

Medical Problems:

Medications Required:

Surgeries:

Ever Required Emergency Care:

Current Dog Food:

Current Feeding Schedule & Quantity:

Any other information that may facilitate us in finding a new home for your dog?

Items You Are Sending with the Dog

Toys Crate/Bed Food Collar w/tags Leash Medication

Please be advised we will want to speak with your veterinarian. Please contact your veterinarian to let him/her know we will be calling and that you authorize him/her and/or their representatives to release all records of your dog to us.

By submitting this form, I hereby swear that the above information is true and complete to the best of my knowledge and ability about the above said dog. I understand that the dog will be further evaluated by Coastal GSR to determine whether or not it is adoptable. All information related to temperament (especially biting incidents) have been disclosed above.

Type in your name:

Today's Date:

We reserve the right to refuse or deny any application

If you are interested in any of our dogs please email us or call 714-528-4730, or you may complete an online application and one of our adoption counselors will contact you.

Donations can also be mailed to
Coastal German Shepherd Rescue
P.O. Box 50726, Irvine, California 92619-0726.
And you can help by shopping through any of the sponsor links on our pages. Thank you for your support.

Broken links? Please email us.