Surrender Form

Surrender_Form_

If needed, the above Form can be printed to be completed.

Is this a Shelter Transfer or owner surrender? GPPR has an alert list for dogs that are seeking help. Do you want this dog and his/her information shared with the people on this list? (your contact information will be provided and shared) First Name: Last Name: Email Address: Phone Number: If owner surrender, are you over 19 yeares of age? Dogs Name: Dogs Age: Female/Male: Where the dog is located (City, State and Zip) Can you help transport, and if so, how many miles? Where did the dog originate from? (Stray, breeder, etc.) When did the dog last receive a rabies vaccination? When did the dog last receive DHPP (DA2PP, DHPPV)? Please check all that apply to this dog: (this helps us to find a foster home fit) Heart worm tested Heart worm positive Crate Trained Nervous Digger Good with cats Good with dogs Good with Children Playful Shy/Quiet Micro chipped Fence Jumper Treated for fleas/ticks House Trained Separation Anxiety Other: What is the reason the dog is being surrendered Other notes you would like to add: What is the date this dog must be placed? I/we certify that I/we, the contact person listed above and/or the submitter of this information, am the legal owner or custodian of, or am authorized by the owner or legal custodian of, the above-referenced dog to post this information. I/we certify that all submitted information is correct to the best of my/our knowledge and belief. I/we agree that Great Plains Pointer Rescue, Inc. (GPPR) and/or its designee(s) have the right to refuse, and might not post, any information GPPR provided by me/us for any cause which GPPR and/or its designee(s) deem to be sufficient. In consideration of the acceptance of this information and the opportunity to have this information posted on the Internet by Great Plains Pointer Rescue, Inc. and/or its designees, I/we agree to hold Great Plains Pointer Rescue, Inc. (GPPR), its officers, members, volunteers, coordinators, fostering agent(s), agents, its Internet service  GPPR  provider(s), Internet presence GPPR provider(s), webmaster(s), and any employees of the aforementioned parties, harmless from any claim for loss or injury which may be alleged to have been caused directly or indirectly to any person or thing by the act of this dog and I/we personally assume all responsibility and liability for any such claim; and I/we further agree to hold the aforementioned parties harmless from any claim for loss of this dog by disappearance, theft, death or otherwise, and for any claim for damage or injury to the dog, whether such loss, disappearance, theft, damage, or injury, be caused or alleged to be caused by the negligence of Great Plains Pointer Rescue, Inc. or any of the parties aforementioned, or by the negligence of any other person, or any other cause or causes. I/we hereby assume the sole responsibility for and agree to indemnify and save the aforementioned parties harmless from any and all loss and expense (including legal fees) by reason of the liability imposed by law upon any of the aforementioned parties for damage because of bodily injuries, including death at anytime resulting there from, sustained by any person or persons, including myself/ourselves, or on account of damage to GPPR property, arising out of or in consequence of my/our GPPR provision of information to, sharing information with, and/or participating in any cooperative efforts with Great Plains Pointer Rescue, Inc. including any handling, fostering, health-related support, or transporting by Great Plains Pointer Rescue or any of the aforementioned parties for the above-referenced dog or any other dog or dogs that might be in my/our care or possession, howsoever such injuries, death or damage to GPPR property may be caused, and whether or not the same may have been caused or may be alleged to have been caused by negligence of the aforementioned parties or any of their employees or agents, or any other persons. By clicking the SUBMIT button, I/we assert that we have carefully read and reviewed the foregoing and agree to be bound by all terms and conditions therein. Please sign and date: