On average we rescue over 100 Danes a year and we now have over 200 volunteers!

Surrender Form

Alternatively, you may download our surrender form as a .pdf and mail it in to us.

SURRENDER OF DOG FORM

* Indicates required fields

Upper Midwest Great Dane Rescue

Date*:


Name of Owner* (please print):


Owners email*:


Home Phone*:


Work Phone*:


Other Phone*:


Address*:


City*:

State*:

Zip*:



Dogs Name*:


Dogs Current Weight*:


Attach a photo of Dog, if possible:

DOB:


Current Age*:



Reason for Surrender*:

 Allergies Moving Finances Illness Unable To Care Other:Explain



If Other, enter reason:

Color*:


Spayed: Y N N/A

Neutered:  Y N N/A

How long have you owned this dog*?

How did you get this dog*?  Stray Gift I bred it Shelter/Rescue breeder

If Shelter/Rescue or breeder, which one:

Is the dog a purebred?  Y N

Is the dog registered?  Y N

If yes which registry and registration number
AKC #

UKC #

CKC #

Is the Dane Microchipped?  Y N

If Yes, enter microchip number and where the number is registered


Tattooed?  Y N

If Yes what does tattoo say or what number and where registered.



Vet records

Vet Name*:


Vet Phone*:


Heartworm Preventative

Heartworm Brand*:

Last Dose Date*:

Food Brand*:


Type*:


Times eats*:

Medical Condition:

Does the Dane have any health problems?

List all*:



Is dog on medications?
 Y N

If yes, what and why?


Does your dog get ear infections?
 Y N

Have skin problems or hot spots?
 Y N




List the ages and sex of the humans that the Dane lived with:





List the ages and sex of other animals the Dane lived with:




Please answer the following questions regarding the personality of the dog:


1. Housetrained?

 Y N

How does the dog tell you he/she needs to go outside*?

2. Has the dog had Obedience Training?
 Y N
What type of obedience*?


3. Does the dog walk nicely on a leash or pull*?


4. How does your dog react if you try to lead him by his collar*?


5. Does Dane get along with male dogs?  Y N

If no please explain what the Dane does:

6. Does the Dane get along with female dogs?
 Y N

If no please explain what the Dane does:

7. Has the Dane been around cats?
 Y N

If yes how does the Dane react/play with cats?


8. When does your Dane bark? Is barking excessive*?


9. Has your Dane ever shown aggression toward another anima?  Y N

If yes, please explain:

(Some forms of Aggression: growling, snarling, lip curling, biting)

10. Has your dog ever shown any aggression towards humans?

 Y N

If yes, please explain:

11. Has your dog ever attempted to bite or bitten anyone?
 Y N

If yes, please explain:


12. Does your dog guard its food or toys from other dogs/people?  Y N
If yes, please explain

13. Can you easily take toys, food, rawhides, bones out of your dog's mouth?
 Y N

14. Describe your Dane when riding in a vehicle*:


15. Where does your dog sleep*?


16. Is your dog used to being crated?
 Y N

Is your dog used to Free Roam
 Y N

17. When your dog is left alone, is it destructive?
 Y N
If yes, please explain:


18. Does your dog chew inappropriate items?
 Y N

If yes, please explain:


19. Does your dog get into garbage or onto the counter?
 Y N

20. Is your dog playful?
 Y N

What are his/her favorite toys/games?

21. How much and what kind of exercise does your dog need each day*?


22. Has your dog ever been swimming?
 Y N

If yes did he/she enjoy the water?

23. Does your dog run away?  Y N

Does your dog Chase cars?  Y N

24. Does your dog like being groomed?
 Y N

Explain:


Does your dog like having his/her toenails clipped?
 Y N
If no, explain:


25. Does your dog like children?
 Y N

If yes, what ages*:

26. Is your dog used to being in a (Check all that apply):

 fenced yard invisible fenced yard outside dog run tied up
27. Does your dog jump fences?
 Y N

If yes, how high:


28. Does your dog dig?
 Y N
29. What scares your dog?
(e.g. storms, separation, grabbing from behind, other dogs, standing men, young children):

30. What does your dog do when scared*?

31. When your dog is being naughty, what is he/she doing*?

Is there anything else we should know that will help us place the dog in a suitable home?





I certify that I am the legal owner of the dog described above and warrant and represent that this dog has never shown signs of aggression towards human beings and further warrant and represent that this dog has not bitten me or any other individual while in my possession. I hereby voluntarily relinquish all claims and ownership of said dog to the organization known as Upper Midwest Great Dane Rescue. ("UMGDR"). I am irrevocably transferring and
relinquishing to UMGDR legal ownership of, and micro chip registration/reregistration rights to this dog on the date hereof. I further acknowledge understanding that the dog becomes the property of UMGDR, and that UMGDR will spay/neuter this dog if intact, and will make every effort to place this dog in a new family setting. However, if the dog has serious health issues, serious behavior issues or aggressive issues, UMGDR has the right to euthanize the dog at its discretion.

By signing this form, I hereby certify that I have honestly answered all of the above questions, to the best of my knowledge, and have read and completely understand the above release.

Signature of Owner: _______________________________________

To be signed at the time the dog is surrendered.

This is a legal binding document. The moment you provide a wet signature on this form the dog you are surrendering belongs to UMGDR. If you decide that you want your surrendered dog back you must go through our adoption process which consists of: application fee, application form, reference checks, home visit, and approval from foster family. Once approved you must be the first approved family interested in your surrendored dog. You may be subject to pay adoption fees including any veterinary costs the dog accrues while in our care. We do not guarantee you will get your surrendered dog back. We make no exceptions to this policy or process.

Upper Midwest Great Dane Rescue is a volunteer group. We request a donation to cover the cost of veterinary expenses, shots, spay or neuter, kennels, food, transportation, etc. Any amount you can give would be greatly appreciated.
Signature of UMGDR Representative to acknowledge receipt of donation in the amount of
$ .