OWNER SURRENDER INFORMATION & CONTRACT

RUSSELL RESCUE CA

Giving a new leash on life
OWNER SURRENDER INFORMATION & CONTRACT

Filling out this form does not guarantee that RRCA will accept your dog. Acceptance into RRCA rescue program is based on many criteria, one of which is space availability.
Personal Information
Full Name*

PrefixFirst NameLast Name
E-mail*
Mobile Number*

Area CodePhone Number
Home Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
It is accepted that the above named person surrenders a canine described as follows:
Name of dog
Age or Aproximate date of birth
Sex of dog
Spayed or Neutered
Please upload proof of Spay or Neuter

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Color/Coat type
Worming due
Vaccinations due
Please upload proof of Vaccinations

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Microchip number
Heartworm treatment
Registered
Pedigree papers
Bred by
Please upload a photograph of your Jack Russell Terrier

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Under the following Terms & Conditions:
I hereby certify that I,*
I am the rightful owner/keeper/caretaker/custodian of the Terrier(s) who is/are the subject of this Animal Surrender Form, hereinafter referred to as “the terrier” I hereby surrender any and all property rights to the terrier. I certify that no other person has a right of property to the terrier. I understand that by surrendering my property rights to the terrier, the terrier may be transferred into the custody of RRCA - Russell Rescue CA. I also hereby certify that the Terrier has/has not [circle one] bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the Terrier, the Terrier will not be available to be returned. I further certify that I have read and understand the terms of this Animal Surrender Form. Please date: **
Are you able to foster your Jack Russell Terrier until RRCA can find a suitable home?*
The following questions are to assist our foster carers & to make the transition into a new environment as easy as possible for your dog. The more we understand about your dog, the easier it will be for us to place him/her.
1. Please tell us a little about your Jack Russell Terrier, how long you have owned your dog & why you are rehoming him/her?
2. Does your dog get along with other animals. If so, which animals? If not, please describe how they react when meeting another animal.
3. Is your dog dominant or submissive with other dogs? Does your dog prefer other male or female dogs?
4. Is your dog prey driven? Do they want to chase cats or small dogs? Has your dog ever injured or killed another animal?
5. How does your dog react when meeting new people, are they friendly, relaxed, boisterous, anxious, aggressive?
6. Does your dog have a particular preference for men or women & how do they behave around children?
7. Does your dog growl or bark when you have visitors. Are they protective of you, your vehicle or your property.
8. Has your dog had any obedience training, can they sit, stay, drop, wait for meals etc.?
9. Does your dog walk well on the lead or does he/she pull? When off the lead, does your dog have good recall?
10. Does your dog travel well in the car?
11. Is your dog used to going to public places, if so, how does he/she behave?
12. Does your dog show any signs of food aggression? Are you able to remove a food bowl or a bone from your dog?
13. Is your dog possessive over food or toys? Will your dog allow another dog near his/her food or toys?
14. If your dog lives with another animal, what is their routine at feed times?
15. What do you feed your dog & how often?
16. Does your dog have any special dietary requirements?
17. Does your dog have any health issues or medical requirements?
18. Does your dog live inside or outside, where are they used to sleeping?
19. Is your dog housetrained?
20. Is your dog crate trained? Has your dog ever been kennelled?
21. How many hours a day is your dog used to being alone? Where is your dog kept when you are out?
22. Does your dog have separation anxiety? If so, what form does this take? Does your dog bark, or become destructive when left alone?
Any other comments
Upload additional photos or documents

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By submitting this form, you are agreeing to the above Terms & Conditions.
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Rescue Dog Co. Representative

First NameLast Name
www.russellrescueca.com

Giving a new leash on life
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RUSSELL RESCUE CA

OWNER SURRENDER INFORMATION & CONTRACT

Personal Information

It is accepted that the above named person surrenders a canine described as follows:

Under the following Terms & Conditions:

www.russellrescueca.com