Contact information of person submitting this request

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail

Description of great dane, hereinafter referred to as "dog"

Registered Name
AKC Number
Call Name
Age	years
Sex	Male Female
Color

Please provide the breeder information:

Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
FAX
E-mail
Website URL

Has the breeder been notified you need to find a new home for this dog?

Yes
No

Please provide the following vet information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

Enter the date of current shots :

-- mm/dd/yy

Has the dog been tested for heartworms?

Yes
No
Unknown

Is the dog on HW preventative?

Yes
No
Unknown

Is the dog altered?

Yes
No
Unknown

Has the dog been bred?

Yes
No
Unknown

Is the dog housebroken?

Yes
No
Unknown

Has the dog been obedience trained?

Yes
No
Unknown

Is the dog good with children?

Yes
No
Unknown

Is the dog good with other dogs?

All dogs
Large dogs only
Small dogs only
Males only
Females only
Unknown

Is the dog good with small animals such as cats?

Yes
No
Unknown

List any known habits the dog has

Does the dog have any preferences to

Men
Women
Unknown

Has the dog even bitten a person or other animal?

Yes
No

If yes, please provide details

Does the dog have any known allergies or medical conditions?

Yes
No
Unknown

If yes, please provide details

Reason this dog is being surrendered REQUIRED

If available, please send a photograph of the dog to rescue@gdco.org
Make sure to label the photo with the dogs name