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?                  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?                        

Dog’s Veterinarian:                                                                               Phone:                                                 

 Will you provide health records?                                  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:                         

Has dog ever bitten, or attacked the livestock it was guarding?                 If yes, describe severity of attack:        

 Does dog dig under, or jump over fences?                                                                                                          

 Is this dog an experienced LGD?                             Has this dog worked as part of a team?                                

 Type and quantity of livestock guarded?                                                                                                 

 Number of fenced acres guarded:                                   Fence type & height:                                                   

 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:                                                        

 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 Bountiful Farm and its owners from any and all liability or responsibility in connection with this dog. I further agree that if this dog show itself to be untrainable or unaacceptable as a working LGD we will accept the dog back and reimburse Bountiful Farm for any medical expenses incurred including spay or neuter.  Among the reasons for a dog not being an acceptable LGD is having joint problems that will inhibit its ability to move freely when necesssary.

 I hereby transfer ownership of this dog to the Bountiful Farm rescue.

 Agreed to this                day of                                                  , 200__.

Owner                                                                                                             

Owner

Owner(s) Address & Phone:                                                  

                                                                                                   Bountiful Farm

                                                                                                   33372 Calhoun Rd.

                                                                                                   Shady Point, OK 74956

   Daniel or Paula Lane, owners                                                     918-649-0494