Fields marked with an asterisk (*) are required. If you try to submit this form without entering a required field, the form will be redisplayed with error mesages in a bold font at the top of the form. Please supply the missing information and resubmit the form.
First Name (*)
Last Name (*)
Street (*)
City (*)
State (*)
Zip (*)
Primary/Home Phone (*)
Work Phone
Cell Phone
Golden's Name (*)
Gender (*)
Age (*)    
Color (*)
Spayed / Neutered (*)
Is dog microchipped
Chip Number
Rabies Tag Number
Origin of Golden
Feeding Schedule
Eating Style
Daily Amount (cups)
Brand of Food
Vet Clinic / Vet Name
Vet's Phone
Shots Current
On Heartworm
Vacination Records
Other Medications
If yes, what medications
Medical Conditions
Signs of Aggression
If yes, details
Was the dog provoked?
House Trained
How do you know the Golden needs to urinate / defecate?
Relations with People
Relations with Dogs
Relations with Cats
Obedience Commands
Other Obedience Commands
Leash Training
Behavior Issues
Where is the Golden while you're gone?
Where does the Golden sleep?
How long is the Golden alone?
Favorite Activities
Any Dislikes?
What are the Golden's best qualities?
What are the Golden's worst qualities?
What is the most challenging trait of the Golden?
When was the last time the Golden played with another dog and where.
Is the Golden an alpha (being the boss) or submissive (rolling over)?
Reason for Surrender
When do you need to surrender your Golden?
Please upload at least one picture of your dog. A picture will help facilitate the acceptance and placement of your dog! Picture file size is limited to 10 megabytes, and picture resolution is limited to 40 megapixels.
Please read the information below and then press the Submit Application button above. This form will be printed and sent to our intake coordinator and your signature will be required when the dog is officially released.

1. GRFR agrees to accept into the rescue program the dog described above.

2. GRFR suggests a donation of $25.00 if possible at the time of surrender to help defray the costs of the rescue service.

3. It is expressly understood by the parties of this Surrender Agreement that the Releaser voluntarily surrenders the above described dog to the rescue service free and clear of any claim of ownership and guarantees that no claim of ownership will ever be made against said dog.

4. Releaser represents and warrants the Releaser is the sole owner of this dog and has the full and complete legal right to release said dog to the rescue service. Releaser will provide any registration papers or medical records upon release to GRFR. Releaser provides full disclosure of all known information regarding the temperament, behavior, characteristics and medical problems and treatments of the dog per the above form.

5. The rescue service assumes all responsibility for the dog's actions after the dog is released. The rescue service agrees to hold releaser harmless for any actions of the dog after it is released to the rescue service unless there is an undisclosed history of aggression or aggressive episodes involving biting. It is mutually agreed by the parties that the only exception shall be if the dog remains in the physical custody of releaser as set forth in paragraph 6.

6. If the dog being released herein remains in the physical custody of releaser until such time as the rescue service finds a suitable home for the dog, it is understood and agreed that the dog is the sole property of the rescue service.

7. DATE effective as of the date set forth in the first paragraph of this agreement.

Your form will not be submitted until after you enter the Security Code and click the Submit button below! By clicking the Submit button you affirm your acceptance of the terms above.
Please enter the Security Code shown above (*) Five characters, a mixture of alphabetic and numeric, no blanks, alphabetic characters are displayed in upper case but may be entered in either case, the displayed symbol for zero has a dot in the center.