Owner Surrender Application Step 1 of 8 - Basic Information 12% HiddenApplication ProcessingHiddenApplication StatusReady for the next stepClosedReady to be assessedWaiting on applicantOn HoldDenyOfficer Review NeededApproved for IntakeDuplicate surrender applicationHiddenAssigned VolunteerAAA Unassigned ApplicationAlison CampbellAlissa BicknaseAllison PutnamAmber PennerAmy DunnAndriea LopemanAngela SchmedemanAngie DysonAnn BethelAnthony DevevoAnthony MontieroApp TesterAsli WhithamAustin WoodsBob GarciaBobG_TestBonnie LassenBrandy NelsonBrenda ParazooBrittney StewartCali McVayCalista WinnettCara KinzelCarol DonahueCarrie BrisbineCassie SchweitzCharyl RayCheryl JacobsonCheryl YochumCourtney ScottCynthia LeCynthia WillsDeb AndersonDiana JonesDonna Jo YarboroughEmily JohnsonEric BergeStoreGinger HickeyGrace ParkHayley GeorgeHeather Frazierhelp deskHV AssignerJackie WaldnerJamie KeenerJennifer PretlowJeremy LambertJoey JonesJoice HagenJulie AnnKangsadan Van AllenKarina LandeKassieKathy SmithKatianne DiBasilioKatie BrodowskiKelli GerisKiera GabaldonKimberly JonesKristopher WilliamsonKristy MartinKyla GabaldonLance SchiedlerLauren ManittaLaurie WestenbergLeah PinachoLillian QuinnLindsey SplaneLindsey StailingLori DavidsonMali GeisterMartha MillerMary BordenMatt NuttbrownMeagan WilkesMichelle AugustMichelle KaufmanMichelle WonderlingMimi MMonica TranMyra MNancy WolfNick BNicole EubanksNikki HutchingsNorma Jean MeakesPatty KellerPaula MageePeg HamlinRebecca CastnerRosy KojuSamSara DiggsSarah BurfordSarah ClarkSarah DavidsonSavanna ThompsonShelby McDonaldShepherds Without BordersStephanie ButcherStephanie SmithSucha SukjaemSue FinneganSusan StutzSusan TaylorSyni BrentTali SmithTamara KendallTammy TateTara SmithTaylor PetersonTeal HickeyTerisaTina SchneiderVanessa Van AlenVivian StrongHiddenApplication Discussion/Notes/copy of emails sent and receivedHiddenDid the owner buy/adopt from a breeder or shelter with a return clause in their agreement?This may require reaching out to the applicant to find out.UnknownYes, there was a contractNo, there was no contractHiddenContract detailsHiddenDog's Records Drop files here or Select files Max. file size: 32 MB. HiddenRecords Outcome No Records Submitted No Photos Submitted No Records Available Records submitted, behind on vaccinations Records submitted, raises concerns Records submitted, looks good HiddenBehavior Questions OutcomeNot yet ratedDog can be safely evaluatedDog cannot be safely evaluatedHiddenBehavior NotesHiddenAssessment Outcome Not Started Completed - Passed Completed - Failed HiddenAssessment NotesHiddenAssessment FilesNote: Videos should go to Google Drive, they're too large for the website.Max. file size: 32 MB.Surrender InformationDog's Name* Picture(s) of your dog Drop files here or Select files Max. file size: 32 MB. Is there a specific date your dog needs a new home by?If there is no pending deadline, feel free to leave this blank. DD slash MM slash YYYY Are you able to foster your dog while we screen potential adopters?* Yes No Owner InformationName* First Middle Last Are you the legal owner of this dog?* Yes No Email* Enter Email Confirm Email Primary Phone Number*Alternate Phone NumberPreferred Communication TypeWe will need to speak with you to discuss your surrender request. No PreferencePhone CallText MessageEmailYour Street Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is the dog living with you?* Yes No Dog's Current Location* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dog's Gender* Male Female Is your dog a purebred German Shepherd?* Yes No I think so Not sure What other breed(s) do you think they have in them?*It's okay if you are not 100% sure, you can give us your best guess! Is your dog spayed or neutered?* Yes No About how old was this dog when they came to live with you?* About how old is your dog now?*Please provide your dog's birthdate, if it's known. Dog's Color(s):* Dog's approximate weight in lbs* Where did you get this dog from?* A shelter A rescue A breeder A pet store A friend Craigslist/A private rehoming I don't remember Breeder/Shelter/Rescue name*Please provide the name and location of the breeder, rescue or shelter you got your dog from.Did you sign a bill of sale or a contract?* Yes No I don't remember What is the reason you would like to surrender your dog?*What would be an ideal placement for your dog?Please describe the perfect adopter for your dog.Please tell us the cute or special things about your dog that may help us find the best possible match for him/her:Is your dog reliably housebroken?* All of the time Most of the time Some of the time No Where does your dog spend his/her days?*Where does your dog spend his/her nights?*How many hours is your dog typically home alone at a time?* Has your dog lived with other dogs?* Yes No How many dogs and what breeds has your dog lived with previously?*Has your dog lived with cats or other small animals?*You will have a chance to tell us about this later on in this application. Yes No Dog Health InformationThis information may help us inform potential foster or adoptive homes about your dog's needs. Please be detailed and specific.Does your dog have any allergies?* Yes No Please list all allergies your dog has:*Does your dog have any medical issues that you are aware of?* Yes No Please explain your dog's medical issues in as much detail as possible*You will be able to upload medical documents belowAre your dog's vaccinations up to date for:* Rabies Bordatella Distemper Leptospirosis Everything recommended by our vet I'm not sure None of these When does the rabies vaccine expire? MM slash DD slash YYYY Do you have your dog's vet records?* Yes, and I can upload them now. I have them but I need to scan and email them. No, I don't have them but my vet will. I will call them for copies. No, my dog has not been to a vet. Vet Records Upload* Drop files here or Select files Max. file size: 32 MB. We need your dog's vet records At a bare minimum, we will need your dog's vaccination records. State laws and our own policies require dogs to be vaccinated against Rabies, Distemper, and to have a recent heartworm test if they're from a part of the country where this is a concern. You can send us your vet record by: Emailing them to rescue@shepherdswithoutborders.org Mailing them to us at Post Office Box #1132, Silverton, Oregon 97381 Is your dog currently taking a heartworm prevention medication?* Yes No When was your dog last tested for heartworm?* Within the last month Within the last year Not Sure Never Is your dog taking any other medications regularly?*This includes flea/tick medication (topical or oral), joint supplements, deworming medications and probiotics. If you are not sure if you should include something, select yes and list it anyway. Yes No Please list ALL medications your dog is taking:*Is your dog microchipped?* Yes No I'm not sure Which company is your dog's microchip from?* HomeAgain AKC Reunite PetLink/Datamars AVID 24 PetWatch Another company I don't remember the company Other Microchip NumberIt's OK to leave this blank if you don't have this available. This should be listed in your dog's vet record. Have you taken your dog to a vet before?* Yes No Yes, but more than 5 years ago Vet DetailsDate of last vet visitApproximate answers are acceptable. MM slash DD slash YYYY Veterinarian's Practice/Hospital Name* Veterinarian's Name Vet's phone numberVet's address or website*If you don't know either, please tell us the city and state the vet is located in. Please describe your dog's personality:*Include what your dog likes and dislikes: what treats or food does he/she prefer? Does he/she like water? Play ball? etc.What toys or games does your dog like?*Can you take toys out of your dog's mouth?* Yes No Sometimes Some toys Is your dog crate trained?* Yes No Somewhat Does your dog have any behavior issues?*This includes everything from minor to major; such as housetraining issues, resource guarding, leash aggression, protectiveness, shyness, timidity, skittishness, etc. Yes No Please describe in detail*Has your dog lived with children?* Yes No What ages are/were the children and how is/was their relationship?*Has your dog had any formal obedience training?* Yes No Trainer InformationHow many weeks of obedience training has your dog received?* Was this training done with more than one company?* Yes No Please provide the name and contact information for the obedience trainers you used*If you only have the name, please also include the city and state. How well does your dog walk on a leash?*Do they pull? Where is their walking position?What commands does your dog perform reliably?*Can you pet your dog while they're eating?*UsuallyAlwaysSometimesNeverCan you take treats out of your dog's mouth?*UsuallyAlwaysSometimesNeverCan you take away the food bowl while they're eating?*UsuallyAlwaysSometimesNeverCan you take away a chew toy or bone?*UsuallyAlwaysSometimesNeverPlease describe your dog’s behavior specifically in each of the following areas and provide any additional insight to help us understand your dog's likes/dislikes.Other Dogs:*Cats and small animals (including small dog breeds):*Children:Strangers:*Being alone in the car:*Riding the car:*Thunderstorms/Fireworks:*Does your dog dislike any specific group of people?Examples may include mailmen, uniforms, men, people in sunglasses, hoodies etc. Does the dog have any type of bite history (including not breaking skin) with:Please be honest, we need the truth to be able to potentially place the dog.People* No Yes (Once) Yes (more than once) Children* No Yes (Once) Yes (more than once) Other dogs* No Yes (Once) Yes (more than once) Any other living animal* No Yes (Once) Yes (more than once) Please explain the circumstances for all of the bites you listed above.*Please tell us if there are any habits or unusual behavior a potential adopter should be aware of:CommentsThis field is for validation purposes and should be left unchanged.
