Owner Surrender Form

Name * First Last
Spouses Name (If Applicable) * First Last
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone * - (###) - ### ####
Alternate Phone * - (###) - ### ####
Email *
Information About Your Weimaraner
Your Weimaraner's Name *
Weims' Sex *
Age *
Age when the Weim came to live with you. *
Where did you get your Weim from? *
If you checked other, where did you get your Weim?
Your Vet's Name *
Your Vet's Phone Number *
If Microchipped, the Name & Number of the Chip
What brand dog food do you feed and how much? *
Medical History
Has your Weim been spayed/Neutered? *
Age of your Weim when it was spayed/neutered? *
Has your Weim been vaccinated for Rabies? *
Date of last rabies vaccination *
Date of last Parvo/Distemper vaccination *
Date of last Lepto Vaccination *
Date of last Bordatella (kennel cough) vaccination *
Date of last fecal exam and results *
Date of last heartworm test and results *
Date of last Heartworm preventative used and brand *
Date of last Flea Tick preventative and brand *
Please list all Medical Treatments and Surgeries *
Please list any current medical issues or conerns *
Getting to Know your Weimaraner
Is Your Weim house trained? * Yes No Working on it
Signal used when your weim wants out *
Is your Weim crate trained? If so, what type * No - Not Crate trained Yes - Wire Crate Yes - Plastic crate
Is your Weim good with other dogs? * No - Needs to be the only dog Yes - Gets along great with all dogs Unknown - Not been exposed to other dogs
Is your Weim good with cats? * Yes No Unknown - Never exposed to cats
Is your Weim good with Children? * Yes - Loves Children Yes - but leary of them No - or has never been exposed to children
Is your Weim good with all women? * Yes - loves women Not Sure No - Very shy around women
Is your Weim good around all men? * Yes - loves men Not sure No - Very shy around men
Is your Weim good around total strangers? * Yes - My Weim loves everyone! Yes - but leary until he/she gets to know them No - my Weim is very protective - GREAT WATCHDOG!
Temperment
Has your Weim ever bitten or snapped at anyone? (If so, what were the circumstances) *
Does your Weim have any Special Needs? *
Please explain fully why your must surrender your Weimaraner for adoption *
By entering my name below, I certify that I am the sole owner of the Weimaraner described above and that I have the right to give it away, I further certify that there are no unpaid vet bills or claims on said Weimaraner. I hereby renounce any and all claims to the above Weimaraner. It is my understanding that Heartland Weimaraner Rescue will do what is best for my Weimaraner in finding a suitable home. I understand the laws of the State of Missouri will govern the interpretation and enforcement of this agreement. With the instrument my Weimaraner becomes the property of Heartland Weimaraner Rescue. I agree to the above terms and conditions.
Agreement Read and Accepted - Enter Full Legal Name

Owner Surrender Form

Owner Surrender Form

Information About Your Weimaraner

Medical History

Getting to Know your Weimaraner

Temperment