PA/DE MAGDRL Surrender Short Form

Mid-Atlantic Great Dane Rescue League requires some basic information before we can complete the surrender process. This form is the first step of the process. The next step is a phone conversation, and then an evaluation.

* Dog Name?

* Source

Owner Turn-in

Shelter

If Shelter, Shelter Name

Owner Information

* First Name

* Last Name

* Address 1

Address 2

* City

* State

Postal Code

* Phone

Email Address

Dane Information

* Dane Name

* Sex

* Color?

* Age?

Purebred

Mix

If mix, with what other breed?

* Ears?

* Is the dane living with Children?

If kids, what are ages?

* Is dane living with other animals?

Please specify other animals

* Is dane up to date on Vaccinations?

* Vet Name

* Vet City, State

* Vet Phone

* Please explain reason giving up in a little more depth

Please click SUBMIT. We'll contact you ASAP via phone or email. Because you've completed this form, our phone conversation will be much shorter. Next step is an evaluation.

* Indicates Response Required

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Moving	Divorce	Can't afford
Aggressive with strangers	Aggressive with family	Aggressive with kids
Fighting with another dog	Bit someone	No time
Destructive when alone	Other