Surrender Form

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PLEASE NOTE, before continuing with your application

We have worked out that every dog that comes into our care costs the rescue on average a minimum of £2,500 per year. This is for food and everyday welfare, this cost does not take into account individual vet visits and treatments, some of which can far out weigh this cost meaning that the average cost plus vet fees can be in the region of £2,500 - £5,000 per year.

Although we try to move dogs into new homes as quickly as we can in a responsible way, depending on their issues, this sometimes can take months if not years, especially with the dogs that are in need of major rehab before being allowed up for adoption.

Therefore we are grateful for every donation that comes into the charity pot, in the case of incoming dogs we ask that the owners or family handing them over contribute towards these future costs by making a minimum donation of £100 when the dog is handed over.

This initial money will stay with your dog for initial vet appointments etc

We understand that some people may struggle with this and if that is the case please put this form on hold and contact us as soon as possible on 01538 750842, ask for the rehoming coordinator and explain your circumstances and how much you can afford.

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Handover Fee Acknowledgement* This field is required.By continuing with this application to rehome your dog, you are acknowledging that you will need to make a one off minimum donation of £100 in order for us to take your dog, Please select the appropriate response below to continue.

I AGREE, ContinueI'm NOT SURE, Continue

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Are you the legal owner?* This field is required.

YESNO

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If you are not the ownerPlease state below why you are completing this form, including any circumstances

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Name:* This field is required.

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Address:* This field is required.

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County:* This field is required.

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Postcode:* This field is required.

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Mobile Number:* This field is required.

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Other Phone:

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Email Address:* This field is required.

example@example.com

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Please upload proof of address & Photo ID

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Dog's Name / Nicknames:* This field is required.

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Please upload a current picture of your dog

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Is your dog a crossbreed?* This field is required.

Yes

No

Not Sure

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Sex:* This field is required.

Male

Female

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Is your dog spayed or neutered?* This field is required.

YESNO

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How old is your dog?* This field is required.

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Date of birth

Date

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Microchip Number:* This field is required.

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Coat Type / Colour:* This field is required.

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How old was the dog when you took them on?* This field is required.

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Where did you get your dog from?* This field is required.

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Is your dog from another rescue?* This field is required.

YESNO

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Which rescue?

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Why can you not hand your dog back to the rescue?

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How long have you owned your dog?* This field is required.

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Why are you surrendering your dog?* This field is required.Be accurate with your answer, we will not judge you, but we do need the truth to enable us to give your dog the best possible future. If they pee in the house, or have bitten please say so

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Is your dog destructive when left alone?* This field is required.

YESNO

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If your dog is destructive, please explain:

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Is your dog house trained?* This field is required.

YESNO

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Is your dog crate trained?* This field is required.

YESNO

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Is your dog muzzle trained?* This field is required.

YESNO

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Please describe your dogs behavior - ON lead* This field is required.

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Please describe your dogs behavior - OFF lead* This field is required.

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Has your dog had previous training?* This field is required.

YESNO

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Give details of previous training

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Is your dog registered with a vet?* This field is required.

YESNO

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Please state surgery and contact number

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Are you happy for us to contact your vet for history?

YESNO

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How does your dog react when at the vets?

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When was your dog last at the vets & why?

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When was your dog last vaccinated?

Date

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Upload a copy of your dogs vaccine card

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

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Does your dog have any known health related issues? * This field is required.

YESNO

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Give details of health issues

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Give details of any current or long term medication* This field is required.

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Does your dog currently live with children? * This field is required.

YESNO

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What ages are the children?

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Please describe your dog's experience with children:

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To strangers?* This field is required.

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To visitors in the home?* This field is required.

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If you try to take away a toy or bone?* This field is required.

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If you take your dog's food while eating?* This field is required.

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Does your dog have any food aggression? * This field is required.

YESNO

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Give more details of the food aggression

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If your dog is disturbed while sleeping?* This field is required.

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Does your dog live with other dogs? * This field is required.

YESNO

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How many, age, sex & breed?

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Does your dog get along with other dogs outside the house?* This field is required.

YESNO

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If yes, please explain your dogs experience with other dogs:

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If no, please explain:

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Does your dog get along with small animals?* This field is required.

YESNO

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Does your dog get along with cats?* This field is required.

YESNO

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Does your dog have behavior issues?* This field is required.

YESNO

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If yes, please explain the behavior issues:

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Does your dog have any fears?* This field is required.

YESNO

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If yes, please list all:

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How is your dog when being groomed?* This field is required.

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How is your dog whilst having his/her nails trimmed?* This field is required.

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Has your dog ever bitten anyone person or animal?* This field is required.

YESNO

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If yes, did it break skin?

YESNO

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Give more details of the incident/sInclude hospital / vet visits, injury descriptions and any costs involved

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Please list a few things you like best about your dog:* This field is required.

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Describe current food and feeding routine:* This field is required.

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Details of any allergies:* This field is required.

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Any additional comments:

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After your dog is added to our waiting list, we will contact you if we need any further information and/or when we have space to bring them into the rescue.

In the meantime you have the following options while you wait:

1. Your dog stays at home with you until a space is allocated

2. You can place your dog into boarding kennels of your choice whilst you wait for a space

3. We can place your dog with our external boarding kennels local to us whilst we wait for a space, and you pay the reduced boarding fees direct to the kennels until a place comes available

Please select your preferred option below

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While you wait for a space* This field is required.I would prefer my dog to ......

Stay at home

Go Into Boarding Kennels of my choice, funded by me

Go to the Rescues External Kennels, of which I am happy to pay for

None of these

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Signature* This field is required.

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Date* This field is required.