Our goal is to place your Weimaraner in a new forever home. To do so, we need as much truthful information about your Weim as you can give us. The more information we have the better we can match them to the perfect home.

Owners Name
Street Address
City
State
County
Zip/Postal Code
Home Phone
E-mail
Referred by
Today's Date
Weim's Formal Name
Weim's Nickname/Call Name
Other Information:	Sex Male Female Color Weight: Spayed/Neutered Yes No If not spayed or neutered, why not? Age of Weim Age at Purchase Date Available / / Where was the Weim Purchased? Name / State / Phone #
If this Weim is a stray, how long have you had it in your possession?
Weim's Breeder
Breeder's Contact Information
Have you tried to contact the Weim's breeder? Reputable breeders always take responsibility for the Weims they produce and usually want their Weims back if you cannot keep it, no matter what the age of the Weim is now.	Yes, we contacted the breeder. What did they say? No, we did not/cannot contact the breeder If no, why not?
	The more we know about your Weim, the better job we can do of finding the best possible home for it. Please answer the following questions as completely and honestly as possible.
Current family includes (please give children's ages)
Do you have other animals? (type, sex, age)
Does your Weim like:	Water (Swimming) Cats Other Weims Children Baths Car Rides Being Brushed Strangers Nails Trimmed
Elaboration on Likes/Dislikes
Is your Weim	Housebroken Crate trained Obedience trained Food Aggressive (i.e. Weim growls if you get near food/bones/toys)
Does your Weim	Chew Bark Jump on people Dig Come when called Walk on lead
Does your Weim know	Sit Stay Heel Down on command Fetch
Can you leave him/her unattended in the house for long periods of time without him/her damaging anything?	Yes No Don't know
Any special training tricks? If obedience trained, when and where?
Your Household activity level	Quiet Active Very Active
Will your Weim jump a	Short (3ft) Fence Tall (6ft) Fence Doesn't try to get out
How high is the fence the Weim is kept in now?
Do you have a local Veterinarian?	Yes No
If yes, Vets:	Name Address Phone Number
Vaccination Dates	DA2PP Rabies Bordatella Corona
Heartworm Preventative	Last Test Date: Is the Weim currently on preventative? Yes No Preventative Type (Brand) What day of the month do you give it?
Weim's feeding instructions
How many meals per day
Amount each feeding
Exercise/Potty Schedule
How does Weim let you know it's time to go outside?
Where is the Weim during the day?
Where is the Weim at night (where does Weim sleep)?
Where does the Weim eat and how much? And what brand?
Describe the Weim's general temperament
Has this Weim ever snarled or snapped? (Be honest)
Has this Weim ever shown fear (of strangers, thunderstorms, etc.)?
Has this Weim ever bitten a person or other Weim? (Be honest)
Why are you unable to keep your Weim?
Additional Comments

I am surrendering my Weimaraner, named , to Florida Weimaraner Rescue, Inc. (FLWR) and wish FLWR to place my Weimaraner and by my signature certify I am the legal owner of the above Weimaraner and the above information is truthful, correct and complete. I certify the Weimaraner has never bitten or been aggressive towards a human. I understand any attempts to mislead or falsify information will result in my Weimaraner either being denied acceptance into FLWR or being destroyer.

Surrender Fee: $100.00 payable to FLWR
(typing your name here is acting as your legal signature to this surrender form)

Signature Date