Your Full Name
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DC District of Columbia
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
RI Rhode Island
SC South Carolina
SD South Dakota
WV West Virginia
Is your dog AKC registered? If so, can you provide original copies of their registration?
Name and number of microchip registry if chipped?
Birth Date or approximate age
Where did you get your dog?
Breeder's name (if applicable)
Did you sign a return contract with the breeder? What is their name and contact
Why are you surrendering your dog?
This dog’s regular veterinarian
Vets Phone #
Does this dog have any physical problems or allergies?
If yes, explain
Is your dog on any medications?
Has your dog ever been on medications or treated for a particular condition? Explain.
Date of last Rabies inoculation?
Date of last Distemper inoculation?
Date of last Bordatella inoculation?
Date of Last Heartworm Test?
Negative or Positive result?
On Which Preventative?
What day of the month is the medication given to your dog?
Your dog’s reactions to
Riding in car
Being alone in car
Walking on Lead
Being alone in house
Being outside in fenced yard
Being alone in fenced yard
Is your dog a digger? Fence jumper?
What does your dog like best?
What does your dog dislike most?
How does your dog act when fearful or unhappy?
Has your dog ever bitten a human?
If yes, explain in detail
If yes, explain in detail
Where does your dog usually sleep at night?
Spend the day?
What brand of food do you feed?
Amount fed and how often?
Has your dog had formal obedience training? If so, list commands known
Has your dog had formal hunt training?
If yes, trainer’s name
List specific hunting commands known and management style used in the field. For
example, whistle, e-collar, hand signals, voice commands, etc.
Any bad habits, such as destructive behavior, separation anxiety, excessive barking,
etc? If so, please explain in detail
Any other information you wish to share?
When do you need your dog placed by?
We will keep your identity confidential from all adoption applicants. However, do
we have your permission to give the person who adopts your dog your contact information?
If yes, what is your preferred method of being contacted? (For example, home or
cell phone number, email only, etc. )
Describe the type of home you would want for your dog
Is your dog invisible fence trained?
Do we have your permission to contact your vet and obtain your dog's records?
To hep us confirm that your dog is a purebred GSP, please upload a recent photo.
To verify you are a real person, Please enter the code you see in the box to the right.