First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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County

Email*

Home Phone

Work Phone
x

Cell Phone*

Alt Email

What is the name of your dog?*

What breed or mix is your dog?*

How old is your dog or Date of Birth (if known)*

Is your dog male or female?*

Is your dog spayed or neutered?

How much does your dog weigh? Estimate if not sure.*

Primary Veterinarian/Practice Name:*

Veterinarian's Phone Number:*

Is your dog up to date on Rabies vaccination?*

Is your dog up to date on Canine Distemper/Parvo Combination Vaccination?*

Is your dog up to date on Bordetella vaccination/nasal spray?*

Has your dog had a heartworm test in the last year?*

Does your dog receive regular Heartworm preventatives?*

Does your dog receive regular flea/tick preventatives?*

Does your dog have any illnesses or injuries that require immediate care or ongoing care? If so, please describe.*

Why are you surrendering your dog?*

Where did you get your dog and how long have you had it?*

Has your dog ever injured another person? If so, please describe what happened.*

Has your dog ever injured another animal? If so, please explain what happened.*

Describe your dog's personality by selecting all of the following that apply.

Is your dog good with others? Select all those that apply.

Is there anything else we should know about your dog?*

Please remember to email a photo to adopt@saveagermanshepherd.org with the dog's name listed in the subject line and with photo. Thank you!