Welcome to National Pyr

Owner Surrender Info

This is a request for information, not a transfer of ownership. Please be advised that the number of owner surrenders makes it difficult for us to take all the dogs we are asked to take. If you obtained your dog from a breeder or another rescue, your first point of contact to relinquish the dog should be them. Our first priority is to dogs adopted out from National Great Pyrenees Rescue (NGPR).

We are asked to take many dogs we cannot accommodate. If your dog was not adopted from our rescue or if an NGPR volunteer did not ask you to complete a form, you may want to look for other alternatives on our rescue contact list, nationalpyr.org/contacts or visit nationalpyr.org/surrenders for other options, including social media groups. Please note many shelters are full and will euthanize owner surrenders shortly after arrival as they are only required to hold strays.

If the dog was found as a stray, many states require that strays be reported to the nearest shelter, although with shelters so crowded they may ask that you continue to hold the dog whenever possible. If you are completing a form for a stray we understand that you may not be able to complete all the questions. Please complete as many as you can. Thank you.

Contact Information

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
-

Email*

Home Phone*

Work Phone
x

Cell Phone

Alt Email

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Surrender Information Request

How did you hear about us:

Dog's Name:

Dog's Sex:

Is this dog spayed or neutered?

Yes

If the dog is an unspayed female, when was this dog's last heat?

Dog's Age: (Indicate if approximate or actual age)

Does the dog have AKC Papers?

Yes

Does the dog have a microchip? Please list the vendor and chip number if known.

Dog's Description: Please describe the color and markings (white, white with grey badger face etc.)

Does the dog have double dew claws:

No	Unsure
Yes

If the dog came from National Great Pyrenees Rescue, please list the dog's name at the time of adoption, the date and what state the dog came from:

If the dog came from a breeder, please list the name, city, state and contact information for the breeder:

If the dog came from another rescue or shelter, please list the name, city, state and contact information for that organization:

If the dog came from a pet store, please list the name, city, state and contact information for the store:

If this dog is a stray, please describe how you found the dog and whether you have made any attempt to search for the owner. (Ex. put up posters, search for owner on Craig's list, notify local shelter, etc.) List any methods used.

How much did the dog cost? (If applicable)

Please tell us your reason(s) for surrendering the dog. You will have the opportunity to describe any particular incidents or events in detail later on in the form. *

Have you worked with trainer or behavioralist?

Yes

Please be specific about the actions that have been taken for training and assessment of your dog's issues as described above. If you have worked with a trainer or behavioralist, please give the name and contact information for that person.

We understand that no dog is perfect. Please answer the following questions as honestly and accurately as possible so that we may better help in placing this dog in the best possible environment. Incomplete forms will not be accepted. Is the dog a:

House Dog	Livestock Guardian Dog
Outdoor Dog

Where does the dog spend the majority of its time?

How long have you had the dog?

Where does the dog sleep?

How is the dog contained?

Chain	Fence
Invisible Fence	Kennel
Roams (not contained)	Trolley

If the dog is contained by a fence, please indicate height and type of fence:

Has the dog ever escaped or jumped a fence? (select all that apply)

Escaped through an open door	Jumped over a fence
Jumped through a glass window	Jumped through a screen window
Tunneled under a fence

If the dog has jumped a fence, please indicate height of fence and type of fence (stockade, picket, wire, electric etc.)

Will the dog run if loose?

No	Unsure
Yes

Is the dog crate trained?

No	Unsure
Yes

If the dog is crate trained, please indicate how often, how long, and the last time the dog used the crate

Is the dog house trained?

No	Unsure
Yes

Will the dog walk quietly on a leash?

No	Unsure
Yes

Will the dog come when called? (select all that apply)

In the house only	Inside and Outside
Not at all	Sometimes

Does the dog get along safely with cats? (select all that apply)

Chases cats inside the house	Chases cats outside
Ignores cats	Inside the house only
No	Sleeps with cats
Unsure	Yes

Does the dog get along safely with other dogs? (select all that apply)

Female dogs only	Large dogs only
Male dogs only	No
Small dogs only	Unsure
Yes

Does the dog get along safely with children? (select all that apply)

Children over 12	Children over 6
Children under 6	Lives with children now
No	Unsure
Yes

Does the dog get along safely with strangers? (select all that apply)

No - reacts aggressively and lunges	No - growls
No - runs away	Yes - greets strangers with a tail wag
Yes - once they are introduced by me	Yes - will allow strangers to approach and pet/rub
Unsure

When food or treats are present, does the dog (select all that apply)

Allows other dogs near their food	Allows other dogs within 6 feet of food
Allows people to take food away	Is aggressive if another dog approaches
Is aggressive if another dog is in the room	Will allow people to take treats/bones away
Will growl or snap if a person attempts to touch the food bowl	Will not allow people or other dogs to take treats/bones away
Will share their food and treats/bones with other dogs

What is the dog fed? Please indicate can or dry, brand (Purina ONE, Purina ProPlan, Alpo, whatever was left over from dinner etc.) and quantity and how often.

Would you describe the dog as

Sedentary	Slightly Active
Very Active

Is the dog destructive in the home (select all that apply)

No	Sometimes Destructive - when left alone for over 2 hours
Somewhat - will chew papers or tissue boxes	Unsure
Very Destructive - Chews windows/doors/rugs etc.	Yes

Please describe any destructive behaviors

Does the dog become anxious when left alone?

No	Unsure
Yes

Please describe your dog's behavior when left alone (anxious if left in the home alone, anxious if tied outside and you leave, etc.)

Is there any history of aggressive behavior toward people?

Yes

If you answered yes, please describe the aggressive behavior in detail and any events leading up to it.

Is there any history of aggressive behavior with other animals?

Yes

If you answered yes, please describe the aggressive behavior and type of animal involved

Please tell us everything you can about the dog's history, personality traits, training, quirks, etc.

What is the current weight of your dog (in pounds)

Please answer the following questions to the best of your ability. If you don't know the date of a vaccination or test, simply say "unsure" or "don't know" Does the dog have: (Select all that apply)

Addison's Disease	Arthritis
Diabetes	Ehrlichiosis
Environmental Allergies	Food Allergies
Heartworm Disease	Hip or Leg Problems
Lyme Disease	Prone to Ear Infections
Skin Issues (hot spots)

If you checked any of the above boxes, OR if your dog has a medical issue that is not listed, please explain.

Date of last DHLP vaccination and expiration date

Date of Last Rabies Vaccination and Expiration Date

Date of last Bordatella vaccination and expiration date

Date of last Lyme Vaccination and expiration date. If you are updating vaccines prior to surrender, please DO NOT give the lyme vaccine. We do not recommend it for this breed.

Date of last HeartWorm test

Date given and type of Heartworm Preventative (HeartGard, Ivermectin, Trifexis etc.)

Date Flea/Tick preventative last applied and type (K9 Advantix, Trifexis, Frontline etc.)

Date of Last fecal exam for worms and Date/Type of worming (if applicable)

Veterinarian's Name:

Veterinarian's Telephone Number

Number of people in your household

Ages of Children living in the household

Do you currently own other dogs?

Yes

If you have other dogs, please list: Breed, Age, Sex, and whether spayed or neutered

Do you currently own other pets? (cats, guinea pigs, birds, etc.) If so, please indicate type of animal, age, sex, and if spayed or neutered

How long are you able to hold the dog you want to surrender?

Will you help transport the dog?

No	Unsure
Yes

I agree to an online Behavioral Assessment by a qualified behaviorist as a prerequisite to surrendering this dog.

Yes

Please acknowledge and initial below: The answers supplied are true to the best of my knowledge

I acknowledge & accept this statement

I disagree with this statement

Submission of this form is not a transfer of ownership nor a contract between NGPR & I. Submission of this form does not imply a guarantee that NGPR will accept my dog.

I acknowledge & accept this statement

I disagree with this statement

I understand that I must email a picture of my dog to info@nationalpyr.org or text a photo to 518-610-1338 for this application to be considered by NGPR. Please include your name and the name of the dog with any photo submissions.

If NGPR agrees to accept a Transfer of Ownership from you to take possession of your dog for re-homing,

I will NOT supply AKC registration records as my dog is not AKC registered	I will NOT supply veterinary records for my dog as there are none
I will supply AKC registration records	I will supply veterinary records for my dog

As part of the evaluation for accepting your dog, we will contact your listed veterinarian. I hearby provide authorization to release veterinary information and medical records regarding my pets to representatives of National Great Pyrenees Rescue. (please initial)

By submission of this information, and my(our) initials in the following box, I(we) attest that I currently have ownership of this dog, have made a serious effort to find the owner of the dog if he/she is a stray and that the information provided on this application is true and accurate to the best of my(our) knowledge.

I(We) understand that completion and submission of this form does not constitute a transfer of ownership nor that National Great Pyrenees will accept my(our)dog. Should NGPR decide to accept this dog, I (we) agree that upon written notice of acceptance into the program, that I(we) will work with the rescue in good faith.*

FOR INTERNAL USE ONLY

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