Surrendering to New Zealand Chihuahua Rescue
Please add as much detail as possible to this form as it will help us to select the most suited foster parent in terms of experience, skill level and ability to foster. We ask as much information as we can to make sure they are comfortable and happy when entering our care.
Full Name of the Owner of the Dog
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Please provide your first, middle and last name
Are you the...
Please Select
Legal Owner of Dog
Power of Attorney of Owner
Family Member of Owner
Friend of Owner
Other
Please note: this form MUST be signed by the legal owner of the dog or Power of Attorney
Phone Number
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-
Area Code
Phone Number
Email
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Please note: our primary contact method is via email rather than phone.
Address
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Street Address
City
Suburb
Postal Code
Are there any other "owners" of the dog?
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Yes.
No.
Other
If there are other owners, please confirm their details and the scenario so we are confident there will be no issues or dispute over legal ownership if we assist with the dog:
(ie. their name, contact details and/or other relevant details - for example, whether they are aware and/or consent to the surrender, or are incapacitated and unable to understand (in the case of Enduring Powers of Attorney surrendering pets on behalf of the owner, for example)
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Name of Dog
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Please confirm the name of the dog you wish to surrender - please submit ONE FORM per EACH DOG, if there are multiple dogs surrendered at once.
Date of Birth (if known) or Approximate Age:
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If you know the date of birth for the dog, please confirm.
Breed
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Please clarify their breed or breed(s) here
Weight (KG)
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Please confirm their current weight (or an estimate)
What is the gender (of the dog)?:
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Male
Female
Is the Dog known to be social with other dogs?
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Yes
No
Other
Is the Dog known to be Cat Friendly?
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Yes
No
Unknown/Untested
Other
Is the Dog Social with People or Strangers (generally)?
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Yes
No
Is the Dog House-Trained
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Yes
No
Other
Where does the dog sleep currently?
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Please Select
Human Bed
Inside (where they like)
Crated
Outside
Please let us know where they currently sleep
How long are they able to be left alone at home (without human company)?
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Please provide an estimate if unknown. We need to consider whether the dogs require a foster parent able to address any separation anxiety or other issues.
Do they live with any other animals? Please confirm details:
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Consider: cats, dogs (confirm breed), birds, farm animals.
Do they have any experience with children? Are they child-safe?
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Please provide as much detail as possible - including ages of children you feel would or would not be suitable around the dog. (ie. "fine for children over 5 years who know about dogs.")
Is the Dog crate-trained
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Yes
No
In progress
Please tell us about the dog's personality:
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What are their personality traits? Do they have any likes or dislikes? Are there any special circumstances we need to know when considering which foster home is best suited for them?
Do they have any medical issues we need to address?
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Please be as honest as possible - this will help us to book in any vet appointments needed.
When did the dog last recieve a flea/worm treatment?
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Day-Month-Year
Do they have any behavioral issues we need to address?
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Consider their sleeping routines, behavior with children or other dogs, any unwanted barking, toilet-training issues, if they are reactive on lead, or known to nip etc. and please let us know so we can address this)
Current dog food (brands) and any diet sensitivity details?
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Please confirm the brand of food as we can ensure we have this on hand and/or any other feeding details - this will help us avoid any tummy upsets when they enter foster care.
Are they De-sexed?
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Yes
No
Are they Micro-chipped?
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Yes
No
Unknown
Are they Registered with the Local Council?
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Yes
No
Unknown
Are they registered with the New Zealand Kennel Club now known as "DogsNZ"?
Yes, I have their details.
No.
Other
When were they last flea/wormed?
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Please confirm the date or approximate date or their last treatment if known and BRAND NAME of their treatment. If they've not been flea/wormed recently please let us know and we can send this to you prior to them coming into care.
Do you have a vet book to provide with them?
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Yes
No
Which Vet clinic did the dog attend? Please confirm the details for the vet clinic or multiple clinics below:
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Please confirm name and contact details (email and phone) if we have their vet history, we can provide more comprehensive care.
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Are you able to contact the vet(s) for the medical history? (please ask them to email this to us: contact@nzchihuahuarescue.co.nz)
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Yes - I have done so.
Yes - I will do that now.
Other
What is your reason for needing to surrender your pet?
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Please confirm the reason you need to surrender your dog - For example: whether it is due to any renting or housing issues, owner is ill or entering residential care, the death of the owner, unable to afford medical treatment for the dog, behavioral issues or incompatibility with current pets etc.)
Have you inquired with family, friends or any prior breeder(s) as to whether they can assist you with the dog? (if able to do so)
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Note: this information is kept confidential.
Proposed Collection or Transport Arrangements:
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We are based in Christchurch and can organize collection locally. If you are in the North Island please confirm whether you have considered arrangements to ensure the dog is able to travel to Christchurch. See information on our website under "re-homing" in this regard for assistance.
Please upload RECENT photos of the dog (note the limits below)
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Upload Recent Photos or Video Here!
SUBMISSION REQUIREMENTS: Limit is a MAXIMUM of 10 uploads. Please only attach RECENT photos or videos of the dog, we don't need older photos. File types accepted are: pdf, doc, docx, mp3, wma, mpg, flv, avi, jpg, jpeg, png.
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Please sign below to confirm your acknowledgement and agreement that as the the true legal owner of the canine described above, you unconditionally release to New Zealand Chihuahua Rescue Trust and/or any representative of the Trust, the canine described above in full which shall become the absolute legal property of the Trust. You grant the Trust permission to alter any details held by the New Zealand Companion Animal Register, Council, Dogs New Zealand, or any other dog database they may be entered into. You further grant the Trustees permission to contact any former vet clinic to have their full and complete medical records transferred to the Trust’s clinic. All information provided to the Trust is true and accurate to the best of my knowledge.
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