This form must be filled out by someone who has legal responsibility for the dog in need. Dog InformationDog's Name *Dog's Age *Dog's Sex *MaleFemaleDog's Color *Black and WhiteLiver and WhiteOrange and WhiteLemon and WhiteSpayed/Neutered? *YesNoRegistered? *YesNoDog will be put to sleep if not adopted/fostered byDog's City *Dog's State/Province *WeightExtremely ThinUnderweightAverageOverweightWeight in Pounds (if known)Height (at Shoulder)Under 21"21" - 23"24" - 26"Over 26"Reason for Surrender *VaccinationsRabiesYesNoRabies Vaccine Type1 Year3 YearDate of Rabies VaccinationDHL-PYesNoDate of DHL-P VaccinationKennel CoughYesNoDate of Kennel Cough VaccinationParvoYesNoDate of Parvo VaccinationCoronaYesNoDate of Corona VaccinationLymeYesNoDate of Lyme VaccinationGiardiaYesNoDate of Giardia VaccinationHeart Worm InformationHeartworm Status *UnknownNegativePositiveNeeds Heart Worm Treatment *YesNoOn Heart Worm Preventative *YesNoBehavior InformationGood with KidsGood with DogsGood with CatsHas Had Basic Obedience TrainingShows Pointing InstinctHas Been Hunted OverNeeds Work WithDiggingNot HousebrokenDestructive ChewingJumping on PeopleJumping on CountersJumping FencesJumping on FurnitureAggressive BehaviorBarkingWhiningAfraid of WomenAfraid of MenAfraid of ChildrenTimid Around StrangersSensitive to NoisesGun ShyOther Behavior Issues:Please upload any pictures of the dog here (total combined size of uploaded files cannot exceed 8mb)Drag and Drop (or) Choose FilesContact InformationContact Name for Questions *OrganizationContact Street Address *Contact City *Contact State *Contact Zip *Contact Phone *Contact Email Address *Alternate Contact InformationContact Name (If different)Alternate Contact OrganizationAlternate Contact Email AddressAlternate Contact Street AddressAlternate Contact CityAlternate Contact StateAlternate Contact ZipAlternate Contact PhoneI/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 PointerRescue.Org, Inc. (PRO) and/or its designee(s) have the right to refuse, and might not post, any information provided by me/us for any cause which PRO 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 PointerRescue.Org, Inc. and/or its designees, I/we agree to hold PointerRescue.Org, Inc. (PRO), its officers, members, volunteers, coordinators, fostering agent(s), agents, its Internet service provider(s), Internet presence provider(s), webmaster(s), the American Pointer Club, Inc., the American Kennel Club, and any employees of the forementioned 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 PointerRescue.Org, 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 therefrom, sustained by any person or persons, including myself/ourselves, or on account of damage to property, arising out of or in consequence of my/our provision of information to, sharing information with, and/or participating in any cooperative efforts with PointerRescue.Org, Inc. including any handling, fostering, health-related support, or transporting by PointerRescue.Org 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 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 I/We Agree button, I/we assert that we have carefully read and reviewed the foregoing and agree to be bound by all terms and conditions therein. *I/We Agree Submit