ABR Owner Surrender Application

When a Brittany is surrendered to American Brittany Rescue, we ask that it be current on vaccinations, altered, and have a heartworm test. If you're not able to do these things for your dog, please complete this form, then talk to the coordinator in your state about options.

If you're unable to provide records to confirm your Brittany's vetting history, please explain: *

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code

Primary Phone Number *

Alternate Phone

Cell phone

Email Address *

What is the best time to reach you? *

What's the dog's name (if you know it): *

If the dog is with you, how long have you had him?

Where is the dog located? *

I own the Brittany, he's with me.

The Brittany is owned by a relative of mine who has asked me to help find him a new home.

He's in a shelter or other facility

I found the dog, he's with me.

Other

If your answer above was OTHER or
I FOUND IT, please explain:

Please tell us why you want to surrender
this Brittany. Please be specific: *

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Dog's sex *

Dog's age or birth date
(if age is unknown - approximate): *

Is the dog microchipped?
IF YES - GIVE US BRAND AND CHIP # *

Is your dog
spayed / neutered? *

Are dog's shots
up to date? *

Approximate weight: *

Approximate height
(at shoulder) *

If the dog is not current on vaccinations
or if it is still intact,
are you able to take care of those things? *

If NO - please explain

Has he been on HW preventative? *

When was dog last HW tested?

Please describe the condition of the dog's teeth. Have his teeth ever been cleaned? If so - when. *

Please provide any information regarding
known or suspected medical conditions
of this Brittany.

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NOTE: ABR takes in dogs with medical
problems all the time. But 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? *

If you answered YES,
please give us your vet's
name, address and phone.

Please tell us about your Brittany.
Is it... *

Please provide any additional physical
characteristics of this Brittany.

Please submit a photo or two of the dog.

Where did you get or purchase this Brittany?
Please be specific: *

If you purchased the Brittany
from a breeder, did you sign
a contract giving the breed
first-right-of-refusal? *

Have you contacted
the breeder? *

Would you mind if WE contact the breeder?
IF NO - please provide their name and contact information.
IF YES - please explain why.

Do you have:

	AKC or UKC papers?		Registry No.?		Pedigree for this dog?
If you have these, we would like them...

Is this Brittany housebroken?
If "not quite", please elaborate: *

Has this Brittany hunted? If so, please
tell us about his training. *

Please tell us what level of access this Brittany
has to the home. Check all that apply: *

None - he is an 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 night.

Please provide any additional information
about how and when you confine your
Brittany or restrict access to the home.

How is the dog confined to your property? *

physical fence

elecronic/invisible fence

cable / chain / tie out

not confined not confined

If you have a physical fence,
how tall is it? what type?
does the dog escape?

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: *

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 he behave
with CHILDREN? *

How does he behave with other
dogs he knows? *

How does he behave with
strange dogs? *

check as many of the following as you'd like to
describe the dogs behavior and habits. *

What is the dog's behavior in the car?

When in a car, this Brittany usually rides *

How does the dog behave at the vet? *

Elaborate if you would like to

Has this Brittany ever bitten?
if so, did he break the skin?
Was the incident reported?
Please provide as much information as possible. *

Please tell us about any other behavior
issues or anxiety this Brittany may have
that you are aware of. *

Has this Brittany had any formal training?
If yes - please tell us what kind. *

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.

How does this Brittany behave when
walked on a leash? *

Please tell us about this dog's favorite activities

Please provide any additional information
about this Brittany and his situation that
you think would help us place him. *

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?

If yes, please indicate how long you will be able to hold the dog. *

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 him in an appropriate home where he can live out his life. Adoption applicants are carefully screened and ABR’s goal is to place each Brittany in a home where he will be part of the family. *

I understand and agree

CERTIFICATION:
By entering my name and date below, I certify that the information entered on this application is true and correct. I understand that a physical evaluation and temperament test may be performed by an experienced rescue volunteer before ABR agrees to accept this dog into their rescue

Sign full name and date *

Upon acceptance of my Brittany to ABR, I understand and agree by placing my initials 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 ABR.

Inital here *

digs	likes riding in the car
roams	whines
playful	escapes yard
unruly	submissive wetter
outgoing	fearful
chases cats	protective
reserves	chews
friendly to people	jumps on people
hyperactive	noisy
shy	growls
affectionate	friendly to other dogs
likes treats	obedient
one person pet	destructive
overactive	quiet
easy going	aggressive
unpredictable