Owner Name(s):                                                                                                                                              

 Address:                                                           City:                             State:        Zip Code:                             

 Home Phone:                            Mobile Phone:                                       Work Phone                                        

 Reason(s) for surrendering this dog to rescue:                                                                                                    

 Dog’s Call Name:                                              Registered Name:                                                                     

 Micro Chip No:                                                 Color:                                                                                     

 Age or birth date:                                                          Weight:                         Sex:                  Sp/Ntd?           

 Are AKC papers available?                   Will you provide these to GPRO?                  Is dog co-owned?                

 (If yes, you must provide signed release)

 Co-owner’s name:                                                                     Phone:                                                             

 Address:                                                                                                                                                          

 City:                                                                                         State:                Zip Code:                                 

 How long have you owned this dog?                                                                                                                  

 Have you notified the breeder that the dog needs to find a new home?                                                                 

What was the breeder’s response?                                                                                                                    

Was dog obtained from a shelter?                        If yes, give name and location:                                                  

Did shelter request that the dog be returned to them?                                                                                          

Were you given specific information about the Great Pyrenees breed when you obtained the dog?                        

                                                                                                                                  Veterinarian:                                                                               Phone:                                                 

 Will you provide health records to GPRO?                                  Are the dog’s shots up to date?                         

 Has dog received monthly Heartworm preventative?            Type of preventative used?                                      

 If unspayed female, date of last heat cycle?                                Is it possible the dog might be pregnant?           

 Does the dog have any physical problems?                      If yes, please list:                                                         

 Any major surgeries?                                         Allergies?                                 Medication(s)?                         

 Has dog had any obedience training?                                                                                                                 

 Walk on Leash?                           Ride calmly in car?                         Submit to being handled?                            

 Has dog ever bitten or attempted to bite a person?                        If yes, describe circumstances:                         

 Does dog dig under, or jump over fences?                                                                                                          

 What brand dog food does dog eat?                                            Dry/canned?                                                    

 How much does dog eat daily?                                                   Time of day dog fed?                                        

 How does dog react to:

 Other dogs?                                                                   Visitors?                                                                    

 Children?                                                                       Cats?                                                                         

 Chickens, or other fowl?                                                 Thunderstorms?                                                         

 Other loud noises?                                                         Verbal reprimand:                                                        

A donation of  $                         to the Great Pyrenees Rescue of  Oklahoma to help off-set incurred veterinary expenses and care of the dog while in rescue accompanies this transfer.

 I certify by my signature below that I am the sole and legal owner of this dog, and there are no encumbrances to its title of ownership.  I agree to release and hold harmless Great Pyrenees Club of America and their Oklahoma rescue representatives, their officers, directors, and members from any and all liability or responsibility in connection with this dog.

 I hereby transfer ownership of this dog to the Great Pyrenees Rescue of Oklahoma

Agreed to this                day of                                                  , 200_.

Owner                                                                                                               Daniel or Paula Lane, representative

Owner

Owner(s) Address & Phone:                                                                        Rescue Address & Phone: 

                                                                                                                                                                                                         Great Pyrenees Rescue of Oklahoma

                                                                                                                            33372 Calhoun Road

                                                                                                                            Shady Point, OK 74956

                                                                                                                            918-649-0494