Animal Surrender Form

Golden Retriever Rescue

Rehoming Co-ordinator: Mel Healey

tel: 07771 646945

Animal Surrender Form

Animal Name
Urgency of rehoming *
Date animal needs to be rehomed by? If you do not have a deadline date please leave blank
Photograph * Please upload jpg or jpeg files only
Owner's reason for parting with animal * Please give as much detail as possible as to why you need to rehome the pet. This will allow the rescue to determine whether they are able to help .
Animal current location *
Species *
Breed *
Sex *
Age * Do not enter 0. If under 12 months old please enter 1
Date of Birth
Describe your animal * Please provide as much information as you can regards their character, behaviours, concerns, likes and dislikes.
Is the animal microchipped?
Microchip Number *
Do you give us permission to transfer the microchip to the Rescue?
Where did you get the animal from initially? *
Socialisation
Can the animal live with children?
If so, please specify ages Please describe the animals behaviour around the children.
If no, has the animal met children and what was his/her reaction?
What age groups were any children met?
Can the animal live with dogs?
Please describe experience with other dogs Please describe the animal's behaviour around dogs.
Can the animal live with cats?
Please describe experience around cats
Has the animal lived with animals other than cats and dogs?
If so, please give more details
Is the animal used to men and women? * Please state if there is a preference / or if the animal is particularly keen or averse to one gender
What things does your pet particularly like *
What does your pet dislike or worry about ? *
Behavioural
Has your dog ever showed any aggression towards people ? * If yes, please describe in as much detail as possible
Has your dog ever bitten another dog * If yes please describe full circumstances
Has your dog ever bitten a person ? if yes, please describe full circumstances and how severe the bite was. If there have been several bite incidents please detail each one
Has your dog ever displayed any resource guarding? if yes, please describe what the dog guards, what behaviours they exhibit, in as much detail as possible
Will the animal give up toys when commanded to?
What is the animal's reaction if you approach it when it is feeding?
Does the animal have separation anxiety ? If the animal is destructive or distressed when left alone for even short periods
Do you leave the animal alone for any period of time? If so, how long for and do you have concerns about them being on their own?
Does your dog bark when left alone ? *
Has the animal ever been destructive in the house? Please describe
Does your dog react to other dogs when on walks ?
How does your pet react to people visiting in the house ?
How does your animal react to grooming?
How does your animal behave at the vets?
How does your animal react when he/she has done something wrong? How do you "tell him off"?
Would you describe your animal as a gentle player or does he/she like "rough" play? Describe your animal's play activity, eg. favourite game, favourite toy, etc.
Does the pet travel well in cars?
Does the animal pull on the lead?
What commands does your animal obey? And what commands are used? For example, sit or sit down; lie or lie down etc.
Does the dog return when called whilst off the lead?
Is the animal housetrained?
Does your pet routinely use a crate ?
Health
Is the animal upto date with its annual vaccinations?
Date of last vaccination
Vaccination Card Photo Please upload a photograph of the animal's vaccination card showing animal name, microchip number, and vaccination history
Is your pet up to date with flea and worming ?
Date of last flea / worming treatment
Has the animal been neutered? *
Date Neutered
What is the animal's normal daily routine *
Please describe your animal's feeding regime - brands of food, scraps, dry or tinned, flavours, feeding times and quantities. Any dislikes?
What will your dog take with them ? * Please tell us what your animal will be able to bring with them to their new home. At minimum you should send them with a couple of weeks supply of their current food. Please detail whether you will also be sending them with their bed, toys, lead, collar, toys etc
Does your pet have any health issues ? Please give as much detail as possible
Is your pet on any regular medication ? * If yes, please ensure you list all medications, doses, and what condition they are prescribed for
Current Vet Name *
Vet Address *
Town *
County *
Vet Email Address *
Do you give your vet consent to share medical history? If yes, this surrender form with this consent will be sent to your vet to apply for their medical history
Person providing information *
First name
Surname
Address
Town *
County *
Postcode
Home Phone Number
Mobile Number
Email address
Are you willing to make a surrender donation towards the ongoing work of the Rescue, which will include care for your animal ? Our decision whether to accept your pet is not reliant on a donation. A donation is not mandatory but does support Rescues in the work they do
Donation Amount
Are you wishing to surrender ownership of your pet to the Rescue, in full knowledge that the animal will be rehomed and relinquishing all rights to the animal ? Whilst we endeavour to maintain contact with previous owners, the animal will become the responsibility of the rescue, and eventually their new home and we cannot guarantee that ongoing updates will be available in all circumstances
Please type your name in lieu of a signature of your intention to surrender your pet
Date of signature

Animal Surrender Form

Socialisation

Behavioural

Health