Hear No Evil Rehoming Assistance/Surrender Form

Hear No Evil Rehoming Assistance/Surrender Form

We can not guarantee that we are able to bring your dog into care but we will help you in whatever way we can.
Name:*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Phone number *
Email*
Date:*

MonthDayYear
Today's date
You must be the legal owner of the dog in order to re-home it.

You must provide full disclosure of the temperament and health of your dog via this form.

You will require the following information as part of the submission.

* Dates of desexing, vaccination, worming, and council registration renewal and registration number.
* Copy of the desexing and vaccination certificates for uploading
* Several clear photos of your dog
Animals Name:*
Age/DOB
How old is your pet?
Breed*
Microchip No*
Last know heartworm treatment date*
Last know flea treatment date*
Upload pctures of your dog here*

Add photo

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How urgent is rehoming required:

Very Urgent - within one weekModerately urgent - within two weeksNot UrgentOther
Why do you need to rehome your dog?*
Is there any circumstances where you would keep your animal?*
Check the corresponding boxes to inform Hear No Evil Australian Deaf Dog Rescue as to whether or not your pet has any behavioral concerns worth noting or working on while in foster care. Any items marked Yes will be worked on. Any items marked Maybe will be evaluated.
Is your dog an escape artist?*

YesNoUnknown
Does your dog struggle to be confined (in a crate)?*

YesNoUnknown
Is your dog reactive to seeing dogs when on leash?*

YesNoUnknown
Is your dog reactive to seeing people when on leash?*

YesNoUnknown
Is your dog destructive in the home?*

YesNoUnknown
Does your dog get anxious/carsick in the car?*

YesNoUnknown
Is your dog toilet trained?*

YesNoUnknown
Does your dog enjoyed treats?*

YesNoUnknown
Is your dog protective of their food?*

YesNoUnknown
Does your dog enjoy playing with toys?*

YesNoUnknown
Is your dog protective of their toys?*

YesNoUnknown
Is your dog protective of their bed/space?*

YesNoUnknown
Is your dog protective of their siblings (if any)?*

YesNoUnknown
Is your dog protective of their handler?*

YesNoUnknown
Is your dog okay with children 0-2?*

YesNoUnknown
Is your dog okay with children 3-5?*

YesNoUnknown
Is your dog okay with children 5-8?*

YesNoUnknown
Is your dog okay with children 8-12?*

YesNoUnknown
Is your dog okay with children 12+?*

YesNoUnknown
Has your dog ever lived with other dogs?*

YesNoUnknown
Has your dog ever coexisted with dogs smaller than them?*

YesNoUnknown
Has your dog coexisted with dogs larger than them?*

YesNoUnknown
Has your dog ever inured a dog?*

YesNoUnknown
Has your dog ever lived with cats?*

YesNoUnknown
Has your dog ever injured a cat?*

YesNoUnknown
Type a question
Has your dog been fearful of children?*

YesNoUnknown
Has your dog been fearful of men?*

YesNoUknown
Has your dog fearful of women?*

YesNoUknown
Has your dog ever injured a person?*

YesNoUnknown
incident
Does your dog do one or more of the the following.:

Chases it's own tailChases shadowsSnaps at the air for no apparent reasonFixated on lights or on one particular spotConstant runs boundary fencePounces at ground but there is nothing there
Does your animal have any health issues we should be aware of?*
What is the name, address and phone number for your current vet?*
Upload Medical/Vacination/Desexing Certificate here.*

Attach documents

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Rehoming Assistance/Surrender Request Acknowledgment*

I hereby give Hear No Evil Australian Deaf Dog Rescue permission to request all medical history and medical records from my Veterinarian for the animal i am requesting assistance for.I hereby confirm that I am the legal owner of this animal, and all information provided is true and correct to the best of my knowledge. I confirm that this animal has not been declared dangerous and there are no outstanding fines, complaints or local council orders with regard to this animal.I understand and agree that by signing this form I am authorising Hear No Evil- Australian Deaf Dog Rescue to assist in a private rehoming of my pet. I understand that Hear No Evil are under no obligation whatsoever to take my pet into their care.
Please type that you understand and agree to the above:*
Signature*

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