Your Name (required) Your Email (required) Alternate Email (required) Street Address (required) City (required) State (required) Zip (required) Home Phone (required) Work Phone Cell Phone How did you hear about us Dog's name Upload a photo of the dog (file size must be less than 3mb, file type must be one of: JPG, JPEG, PNG, TIFF, BMP, GIF) Gender malefemale Is this dog spayed or neutered YesNo Dog's Age (Indicate if approximate or actual age) Does the dog have AKC Papers? YesNo 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 YesNoUnsure Where did you obtain this dog? BreederNational Great Pyrenees Rescue (NGPR)Other RescuePet StorePrior OwnerShelter If you selected "Other" above, please indicate how you obtained the dog. How much did the dog cost? (If applicable) Your reason(s) for surrendering the dog: 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 DogLivestock Guardian DogOutdoor 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? ChainFenceInvisible FenceKennelRoams (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 doorJumped over a fenceJumped through a glass windowJumped through a screen windowTunneled 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? YesNoUnsure 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? YesNoUnsure Will the dog walk quietly on a leash? YesNoUnsure Will the dog come when called? (select all that apply) In the house onlyInside and OutsideNot at allSometimes Does the dog get along safely with cats? (select all that apply) Chases cats inside the houseChases cats outsideIgnores catsInside the house onlyNoSleeps with catsUnsureYes Does the dog get along safely with other dogs? (select all that apply) Female dogs onlyLarge dogs onlyMale dogs onlyNoSmall dogs onlyUnsureYes Does the dog get along safely with children? (select all that apply) Children over 12Children over 6Children under 6Lives with children nowNoUnsureYes Does the dog get along safely with strangers? (select all that apply) No - reacts aggressively and lungesNo - growlsNo - runs awayYes - greets strangers with a tail wagYes - once they are introduced by meYes - will allow strangers to approach and pet/rubUnsure When food or treats are present, the dog (select all that apply) Allows other dogs near their foodAllows other dogs within 6 feet of foodAllows people to take food awayIs aggressive if another dog approachesIs aggressive if another dog is in the roomWill allow people to take treats/bones awayWill growl or snap if a person attempts to touch the food bowlWill not allow people or other dogs to take treats/bones awayWill 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 SedentarySlightly ActiveVery Active Is the dog destructive in the home (select all that apply) NoSometimes Destructive - when left alone for over 2 hoursSomewhat - will chew papers or tissue boxesUnsureVery Destructive - Chews windows/doors/rugs etc.Yes Please describe any destructive behaviors Does the dog become anxious when left alone? YesNoUnsure 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? YesNo If you answered yes, please describe the aggressive behavior Is there any history of aggressive behavior with other animals? YesNo 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 DiseaseArthritisDiabetesEhrlichiosisEnvironmental AllergiesFood AllergiesHeartworm DiseaseHip or Leg ProblemsLyme DiseaseProne to Ear InfectionsSkin 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 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? YesNo 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? YesNoUnsure Please acknowledge and initial below: The answers supplied are true to the best of my knowledge I acknowledge and accept this statementI disagree with this statement Submission of this form is not a transfer of ownership nor a contract between BRGPRE & I. Submission of this form does not imply a guarantee that BRGPRE will accept my dog for re-homing. I acknowledge & accept this statementI disagree with this statement If BRGPRE 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 registeredI will NOT supply veterinary records for my dog as there are noneI will supply AKC registration recordsI will supply veterinary records for my dog As part of the evaluation for accepting your dog, we will contact your listed veterinarian. I hereby provide authorization to release veterinary information and medical records regarding my pets to representatives of Blue Ridge Great Pyrenees Rescue and Education. (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 Blue Ridge Great Pyrenees Rescue and Education will accept my (our) dog as a candidate for re-homing. Should BRGPRE decide to accept the dog into its owner surrender program, I (we) agree that upon written notice of acceptance into the program, that I (we) will work with the rescue in good faith to help them rehome my (our) dog.