Pupcakes Rescue and Rehab

Pupcakes Rescue and Rehab

Enquiry for rehabilitation and assessment placement
To enquire about available spaces for behaviour and assessment placements, please complete the following form.
Information about the Charity/Organisation
Name of Charity/Organisation
Primary Address of Charity/Organisation

Street Address

Street Address Line 2

CityCounty

Post code
Contact name

First NameLast Name
Position held within Charity/Organisation
Primary contact number

Area CodePhone Number
Alternative contact / mobile number
Please enter a valid mobile number.Format: (+44) 0000 000000.
Email
Example- dogrescue@gmail.com
Please select ways we can contact you:
About the Dog.

For us to be able to assess your request, please fill in as much information as possible
Dog’s name:
Breed:
Sex:
Age:
Neutered
Vaccinated
Date of last vaccination

DayMonthYear
Behaviour assessment

To help us determine the best training/support approach necessary to helping the dog, please fill in as much information as possible.
What support are you requesting from “Pupcakes Rescue and Rehab”?
Please feel free to explain further how you would like “Pupcakes Rescue and Rehab” to assist in your request for a behaviour/assessment placement.
Rehabilitation or training you would like us to undertake or evaluations you would like for us to put together for your organisation
Does the dog have a bite history?
Bite level-
Please select all known options relevant to the dog- if exact triggers are unknown please select "undefined" in the relevant catagory
Resource guarding:
Reactivity:
Anxiety:
Please explain the circumstance(s) of the behaviour and/or bite(s), if known:
Has the dog seen a Veterinary professional to rule out pain/health causes for the behaviour, if so please explain?
Please attach a clear photo of the dog:

Cancelof
I consent to “Pupcakes Rescue and Rehab” storing my personal details on their database should I need to be contacted
I confirm that I have the authority of the Rescue/Organisation to consent for their data and information to be processed for the following purposes:
Should be Empty:

Pupcakes Rescue and Rehab

Information about the Charity/Organisation

About the Dog.

Behaviour assessment