Owner Surrender Application Owner Surrender Application"*" indicates required fieldsName* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code United StatesCanada Country What is the best time to contact you?No PreferenceDaytimeEveningWhat is the best way to contact you?No PreferencePhoneEmailDog's Name (if known)State the dog is located*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon TerritoryWhere is the dog located?*I own the Brittany, and it is with me.The Brittany is owned by a relative, who has asked me to help find it a new home.In a shelter or other facility.I found the dog, it's with me.OtherIf you found the dog, or selected other, please explain below.*Please tell us why you want to surrender this Brittany. Please be specific.*What is the dog's gender?*MaleFemaleIs the dog spayed or neutered?*YesNoAltered Date (if known) MM slash DD slash YYYY Dog's weight in pounds. Approximate if unknown.*Dog's height at shoulders in inches.*Please select the dog's color.*Orange and WhiteLiver and WhiteTri-ColorOrange RoanLiver RoanTri-RoanBlack and WhiteDog's age, approximate if unknown*Dog's birthdate (if known) MM slash DD slash YYYY Please provide any additional physical characteristics about the Brittany here.Is the dog microchipped?*UnknownYesNoMicrochip Manufacturer*24PetWatchAvidAKC ReunitePetKeyHome AgainPetLinkFound Animals RegistryAKC CARSave This LifeTruepawsOtherIf you selected other, please let the microchip manufacturer here.*Microchip number*Is the dog up to date on vaccinations?*YesNoUnknownIf the dog is not current on vaccinations or if it is still intact, are you able to take care of those things?*YesNoIf no, please explain below.*Has the dog been on heartworm preventative?*YesNoUnknownWhen was the dog last tested for heartworm? MM slash DD slash YYYY Please describe the condition of the dog's teeth.*Has the dog had dental cleaning?*UnknownYesNoPlease select the date of dental work.* MM slash DD slash YYYY Please provide any information regarding known or suspected medical conditions of this Brittany.*ABR takes in dogs with medical problems all the time. If your dog has a condition that you're aware of, you could save us a lot of time and money by telling us rather than making us find out for ourselves.Do you give consent for ABR to contact your Brittany's vet to obtain or verify his medical history?*NoYesN/AVeterinary Clinic Name*Veterinarian Name* First Last Phone*Please include a photo or two of the dog. Drop files here or Select filesMax. file size: 256 MB.Where did you get this Brittany? Please be specific.*Did you get this Brittany from a breeder?*NoYesDid you sign a contract giving the breed first-right-of-refusal with the breeder?*YesNoHave you contacted the breeder?*YesNoWould you mind if ABR contacted the breeder?*YesNoBreeder's Name* First Last Breeder's Phone*Breeder's Kennel NameIf you have papers for this dog, please attach them here. AKC, UKC information, Registry number, and Pedigree. Drop files here or Select filesMax. file size: 256 MB.Is the Brittany housebroken?*YesNoUnknownHas this Brittany hunted?*UnknownNoYesPlease tell us about this Brittany's hunting training.*Has this Brittany had any other formal training?*UnknownYesNoPlease describe the training below.*List any tricks or commands that this Brittany knows. If you use commands - tell us what the command is and what behavior you expect from the Brittany.*Please tell us what level of access this Brittany has to the home. Check all that apply:* None - Outdoor dog Confined to certain areas at all times Confined to certain areas when not supervised Has the run of the house at all times Has the run of the house when supervised Has a dog door available Crated when not supervised Crated at nightPlease provide any additional information about how and when you confine your Brittany or restrict access to the home.How is this dog confined to your property outdoors? Select all that apply.* Fence Tie out tether Not confinedWhat type of fence do you have?*Privacy fenceChain link fenceInvisible/ElectronicOtherHow tall is the fence?*If you selected other, please explain below.*Will this Brittany allow you to examine and touch his body and feet without a fuss? Please describe any sensitivity to touch by the vet, the groomer or others here.*Please describe the Brittany's behavior around STRANGERS (ie. is he shy, friendly, nervous? Does he have a problem with men? with women? With people in uniform?*How does this Brittany behave around ADULTS he knows?*How does the Brittany behave with CHILDREN?*How does the Brittany behave with other dogs he knows?*How does the Brittany behave with dogs he doesn't know?*Is the dog OK with cats?*NoYesDon't KnowCheck as many of the following as you'd like to describe the dogs behavior and habits.* Digs Roams Playful Unruly Outgoing Chases cats Reserves Friendly to people Hyperactive Shy Affectionate Likes treats One person pet Overactive Easy going Unpredictable Likes riding in the car Whines Escapes yard Submissive wetter Fearful Protective Chews Jumps on people Noisy Growls Friendly to other dogs Obedient Destructive Quiet AggressiveDescribe the dog's behavior in the car.*Select from the following to describe how the dog rides in the car.*Loose in the carIn a harnessIn a doggy seat beltLeashedCratedOtherIf you selected other, please describe below.*How does the dog behave at the vet?*FriendlyShyNervousControllableDifficult to controlNeeds to be muzzledDon't knowOtherIf you selected other, please describe below.*Please provide any additional input about the dog's behavior at the vet if you'd like.Has the dog ever bitten?*NoYesUnknownDid it break the skin?*NoYesWas the incident reported?*NoYesPlease provide detailed information below about the incident.*How does the Brittany walk on a leash?*Please tell us about the dog's favorite activities.Please provide any additional information about this Brittany and his situation that you think would help us place them.*How did you hear about American Brittany Rescue?*If a foster home is not immediately available, can you hold the dog until one is found?*NoYesPlease indicate how long you will be able to hold the dog.*Owner Surrender Consent I agree to American Brittany Rescue, Inc.'s Owner Surrender policy.Please indicate that you understand and accept our Owner Surrender Process and Terms by checking the “I understand and agree” box. Acceptance of your Brittany into ABR is based on many criteria including the availability of a foster home. ABR will try and place this Brittany with an appropriate foster family close to your area if possible. If the Brittany needs to be transported, we hope you will help with that. If we agree to accept this Brittany into ABR we will do our utmost to place them in an appropriate home where they can live out their life. Adoption applicants are carefully screened and ABR’s goal is to place each Brittany in a home where they will be part of the family.Upon acceptance of my Brittany to ABR, I understand and agree by signing below that I am relinquishing all rights and ownership of my Brittany to ABR and I further understand that I am in no way entitled to have my Brittany back unless certain agreements have been made with a member of the Board of Directors of American Brittany Rescue.Signature*NameThis field is for validation purposes and should be left unchanged.
