Dog surrender/rehoming form

Your Name

Date of Birth

Your Email

Telephone

Address

Postcode

Animals Name

Sex

Date of Birth

Breed

Colour

Neutered

Vaccinated

Vaccination Date

Microchipped

Microchip Number

We would like to ask you the following questions, as this will really help us re-home your pet, so please be truthful! Thank you.

1. Why are you bringing your dog into our rescue for re-homing?

2. How long have you had the dog for?

3. How many children live in your household, include ages?

4. If children visit your home what ages are they and how often do they visit?

5. Has the pet to your knowledge, had any bad experiences with either adults or children?

6. What age of children would you re-home your pet with and why?

7. Is your household busy? (please score 1-10, 10 being the highest)

8. Where does your pet sleep at night?

9. Would you describe your pet as affectionate? (please score 1-10,10 being the highest)

10. Where is the dog kept when home alone? How long on average is the animal left for is he/she happy to be left alone?

11. When left alone does the animal scratch, dig, mess, wet, bark, howl or chew things in the home?

12. Is your pet fully house trained and how do they tell you if they want to go outside? If not where and when does your pet mess or wee?

13. Is the animal allowed on the furniture at home? Do they get off if they are asked?

14. Is the animal scared of anything? If so how do they show it?

15. Is there any food that will upset your pet’s digestion that we should know about?

16. What is your pet fed on, how often?

17. Does your pet show any possessive behaviours towards food, toys and other items? What do they do?

18. If your property fenced? How high is the fencing and has your pet ever tried to escape from the garden?

19. How do you discipline your pet when they have been naughty and how does your pet react?

20. Do you have any other pets in your household? If yes how do they get on (include sex of other pets, age and neutered etc)

21. How does your pet react to other dogs outside the home? Have they ever had a bad experience with other pets? What happened?

22. How does your dog behave around cats?

23. Could your dog live with other pets? Please state what pets

24. How does your pet travel? (loose, car seat belt, cage, in the boot)

25. If your dog is coming into the rescue for behavioural or training concerns, have you sought advice from anyone prior to coming into the rescue? If so who?

26. Are there any ongoing medical issues, treatment or previous injuries that we should be made aware of?

27. How does your pet behave at the vets? Which vets do you use? Are you happy for us to contact them?

28. Does your pet play with toys and which are his favourite? Does he play with these alone or with you?

29. Describe your pet’s behaviour when visitors come to your home?

30. Does your pet display any unusual behaviours such as shadow chasing, tail chasing and fly catching? If yes when does the dog show this?

31. Does your dog show any unwanted behaviours?

32. Does your dog enjoy playing rough and tumble games with you or anyone else? When you stop the game does your dog stop or try to continue playing?

33. Do you find time to walk your dog and how long?

34. Is this on lead or off lead? If you do not let your dog off lead why not?

35. What previous training has your dog had? Does your dog come back when you call them?

36. Does your dog mouth when excited or playing?

37. Has your dog ever growled, snapped or bitten a person? (if yes, who was present, what was happening immediately before, where did this happen? How many times has this happened? Describe any marks/wounds-puncture, scratch or bruise?)

38. Are there or has there ever been any police investigations or court procedures against your dog? Please state all dates and reasons for this?

39. If your dog is female, when was their last season? If applicable

40. Has she ever had a litter of pups?

41. Use three words to describe the pet’s personality?

42. Is there any additional information which you feel may be helpful to us for re-homing your pet?

43. Do you currently have any other animals? If yes, please list details below.

Please upload a recent photo of the pet you are wishing to re-home (max. file size 5MB)

Consent

By signing this form, I hereby surrender / re-home my dog/s to Destitute Animal Shelter to now have full ownership of my dog/s and have full control over any care, veterinary treatment and the adoption of my dog/s. I will no longer be the owner or have any rights over the dog/s and if I do want the dog back while it is at the shelter I will have to go through the correct adoption measures to apply for the adoption of this dog/s.

Full Name Printed

Intake date

Extra notes