Step 1 of 7 - Section 1 - About You 0% The Surrender Intake form is separated into 7 stages. Each stage will be verified for required answers before proceeding to the next section. Your dog will be placed much sooner if you can supply photograph(s). Total size must be less than 1 Mb per picture and the picture format must be jpeg (.jpg). Please, no humans in the photographs! If you do not know the answer to a question, just answer N/A. If multiple choice questions don't show the answer you want, you can enter further explanation in the 'Additional Comments' at the end of the form.Your Full Name:* First Last Do you have an email address:*YesNoEmail:* Enter Email Confirm Email Primary Phone:*Enter only numbers - e.g. 555 555 5555.Cell Phone:Enter only numbers - e.g. 555 555 5555.Business Phone:Enter only numbers - e.g. 555 555 5555.Street Address:*City:*Province:*ONQCSelect your ProvincePostal Code:*Closest major City:Answer this if you live in a rural community.How did you hear about Danes in Distress:Used PreviouslyVeterinarianAnimal ShelterFriend / Associate 2 - About the Great Dane you are surrenderingDane Name:*Age - Years:*Please enter a number from 0 to 15.If less than 1 y-o, enter 0 and then the number of months below.Age - Months:*Please enter a number from 0 to 12.Date of Birth (if known): DD MM YYYY Colour:*BlackBlueMantleBrindleFawnHarlequinMerle or MerlequinWhiteSelect the colour which closest matches.Gender:*MaleFemaleNeutered / Spayed:*YesNoMonth of last Season:Not ApplicableJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberWhat Year:*Enter as YYYY - e.g. 2010Are its ears cropped:NoYesWeight:Specify lbs or kg.Height:Microchip or Tattoo Number:Reason for Surrender:* How long have you had the Dane:*Where did you get the Dane:*BreederFriendInternetIs the Dane CKC registered:*NoYesWill you sign over registration:*NoYesRegistration papers are NOT given to Adopters, but retained on file by DiD.Is this Dane a house pet:*NoYesIs this Dane housetrained:*NoYesIs this Dane leash-trained:*NoYesHas it had Obedience Training:*NoYesDo you ever walk it off-leash:*NoYesDoes it stay with you:*NoYesIs it crate trained:*NoYes Reaction to being crated:*Reaction to other dogs:*Reaction to Cats:*Has it been exposed to livestock:NoYesReaction to Children:*Reaction to Strangers:*Has it ever bitten or shown aggression towards a person:*NoYesDetail the circumstances and any injuries sustained:* What is its General Temperament:*Examples: Happy-go-lucky, fearful, timid, playful, etc.What is its Health status/general condition:*Any Major Health issues or illnesses:*NoYesIs the Dane Deaf:*NoYesIs the Dane Blind:*NoYesSpecify these:*Specify any current medical conditions requiring treatment:*Has the Dane ever been vaccinated:*NoYesDate of Last Vaccination:* DD MM YYYY Check all vaccines given:* Rabies DA2PPV Bordetella Don't know Has the Dane ever had Heartworm medication:NoYesDon't knowSpecify Brand used:*What Year was the Test done:*Vet Clinic used for the Dane:*If no vet, enter N/AVet - Street Address:*Vet - City:*Vet - Phone:* How long has the Dane been left alone:*Where is the Dane kept when no one is home:*Specify any behavioral issues:*e.g. chewing, digging, barking, jumping, etc.The Dane LIKES the following:e.g. Car rides, walksThe Dane DISLIKES the following:e.g. nail clipping, baths, etc.Has it been boarded at a kennel or elsewhere:NoYesHow did it react:What food brand is the Dane currently being fed:*How often is it fed daily:*How much per meal:At what time(s) do you feed:Specify any special feeding instructions: Are you willing to keep the Dane until a suitable Adopter is found:*NoYesCan you keep the Dane at your home until it is altered:*NoYesIf we can place your Dane, will you make a donation to cover expenses:*NoYesAdditional Comments:Do you certify that the answers given are true:*NoYesIf there are Public Health issues (e.g. human aggression, rabies infection) not disclosed, you could be liable for civil action against you!Click on the Choose File buttons below and select the photograph filename on your hard drive Photograph size must be less than 1 Mb per picture and picture format must be .jpg. Upload Picture 1Accepted file types: jpg.Upload Picture 2Accepted file types: jpg.Upload Picture 3Accepted file types: jpg.