Assisted Rehoming Form

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Best Contact Number

Please enter a valid phone number.

Email

example@example.com

Briefly explain why you need to rehome your arctic breed.

Animal Name

Animal Breed (Please note we only accept Akita, Alaskan Malamute, Samoyed, Siberian Husky and their crosses)

Animal Birthdate or Approximate Age

Animal Microchip Number

Colour

Gender

Is this animal desexed? Proof will be required.

YesNo

Is this animal up to date with it's vaccinations (minimum C5 level)?

YesNo

If we accept this animal into our program we will ask you to complete a more detailed and thorough profile form. For the time being we appreciate responses to the following questions.

Is your animal dog social? Check all that may apply.

If dog social, does this include small dogs?

YesNo

What humans does your dog like? Please check all that apply.

Can this dog live with another dog in harmony?

YesNo

What type of playfriend(s) does this dog prefer?

Is this dog a "dog park" dog?

YesNo

Does this dog resource guard any of the following against humans?

FoodToysAttention

Does this dog resource guard any of the following against other dogs?

FoodToysAttention

Does this dog have any medical issues?

YesNo

If you answered yes to any medical issues, please explain.

If this dog is an escape artist how does it escape?

Please check any of the following this dog is friendly with:

If you have a timeframe in which to rehome this dog, please advise what this is.

Is this dog subject to or under investigation for any of the following orders:

Nuisance DogMenacing DogDangerous Dog

Is there anything else we should know at this stage?

Please upload a picture of this animal.

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