Owner Surrender Form

PUPCAKES RESCUE - OWNER SURRENDER FORM
For us to be able to process a surrender request we will require some information about your dog so that we can gauge whether we have the space required to house them, and for us to best evaluate the care needed to support your dog should Pupcakes be able to offer a rescue space at our shelter in Boston, Lincolnshire.
Please do ensure to be as honest and thorough as possible when filling out the form, any behavioural issues or information you offer will not go against your application, but it will enable us to offer safe and thorough information and advice to potential adopters, this way there is a better chance of your dog finding a successfull and happy forever home whilst being as safe as possible.
Today's Date

DayMonthYear
Date
How did you find out about Pupcakes Rescue:
YOUR DATA

For us to be able to assess your surrender request, we will need your permission to store your data and confirmation of how would be best for us to contact you should we be in a position to offer your dog a rescue placement with “Pupcakes Rescue and Rehab”
I consent to “Pupcakes Rescue and Rehab” storing my personal details on their database should I need to be contacted

I agree
Please select ways that we can contact you:

LandlineMobile (voice call/SMS/WhatsApp)E-mailLetterFacebook Messenger
I consent for my data and information to be processed for the following purposes: (please select all options)

To assess eligibility of the dog for a placement under “Pupcakes Rescue and RehabTo share data and information with “Pupcakes Rescue and Rehab” colleagues, behaviourists and Veterinary Professionals for evaluation of the dog and it’s behaviours/history before/if a placement is offered.For “Pupcakes Rescue and Rehab” to store my information and data on their database to allow them to contact me if required, and to keep a record of the dog I am requesting surrender placement for.I am aware that consent for my personal data can be withdrawn at any time by contacting “Pupcakes Rescue and Rehab”
⚠️Please be aware that due to the strain currently placed upon rescue, we are now implementing a £150 fee for surrendering your dog into rescue with "Pupcakes Rescue and Rehab". This will go towards your dog's veterinary requirements, food and basic care whilst here at Pupcakes.

This fee will only be payable if we agree to take on your dog and a date for them to enter rescue is set.
Please confirm that you agree to pay the surrender fee if your dog is accepted into rescue.

I agree
Your name:*

PrefixFirst NameLast Name
If you have contacted us through Facebook under someone else’s account or a different name other than the name provided above then please include that information below for us to link your messages to this form.
Address:*

House name/number and Street

Street Address Line 2

City/TownCounty

Post Code
Landline Number:

Area CodePhone Number
Mobile Number:
Email
example@example.com
Your dog's name:
Colour:
Breed/s:*
Age:*
PLEASE GIVE AN ESTIMATE IF NOT KNOWN
Sex:*

FEMALEMALE
Is your dog microchipped:

YESNONOT SURE
If YES please provide Microchip number if known:
Is the dog neutered/spayed:*
Date of Neutering if known:

DayMonthYear
Date
Is your dog up to date with vaccinations?*

YESNO
If YES, do you have a vaccination card to accompany the dog?

YESNO
When was the date of your dog's last booster/vaccination? (If known)

DayMonthYear
Is your dog up to date for worming and flea treatment:
Why are you surrendering your dog?*
PLEASE PROVIDE AS MUCH INFORMATION AS POSSIBLE
How long have you owned the dog:
How many homes has the dog had:
Where did you get the dog?
Example: Breeder, Rescue (please include name and area of either), Owner Sale - please state area if known.
Please provide the details of the Veterinary practice that the dog is registered to:

Practice Name

Street Address

City/TownCounty

Post code
Veterinary contact number

Area CodePhone Number
Please list any past or present injuries, treatments or other medical history:
Has the dog scratched or bitten anyone within the last 10 days?*

YESNO
If YES, who was bitten:
Date of the bite:

MonthDayYear
Date
Which City:
Has the dog ever (Please tick as applicable):*

BITTENSCRATCHEDLUNGED OR ATTACKEDNONE OF THE ABOVE
If YES, to the dog having bitten, did the bite break the skin?

YESNO
Were the police involved?

YESNO
Please explain the circumstances fully:
KNOWING THE CIRCUMSTANCES OF ANY BITE INCIDENCES WILL HELP US TO IDENTIFY TRIGGERS FOR FUTURE REFERENCE.
Select any of the following that describe your dog:*

ACTIVECOUCH POTATOBARKS A LOTREACTIVE ON THE LEADQUIETPLAYFULFRIENDLYSHYLIKES TO BE FUSSEDAFFECTIONATEFEARFULINDEPENDANTPROTECTIVEALWAYS AT YOUR SIDEINDOOR DOGOUTDOOR DOGNERVOUSHOUSE-TRAINEDCRATE-TRAINEDLIKES MENLIKES WOMENWORKING DOGSEPARATION ANXIETYDOG FRIENDLYDISLIKES OTHER DOGSRESOURCE GUARDEROther
Has the dog lived with children:*

YESNO
Woud you recommend that the dog live with children in the future:

YESNO
If YES, what ages would you recommend :
Has the dog lived with cats:

YESNO
If YES, would you recommend the dog live with cats in the future:

YESNOOther
Has the dog lived with other dogs:*

YESNO
If YES, please describe the other dogs in the home (regular visiting or resident) and whether you would recommend the dog live with other dogs in the future:
How is your dog when around other dogs:*
EX: WHEN OUT WALKING, WHEN APPROACHED BY OTHER DOGS, THROUGH FENCING, AROUND FOOD/TOYS/TREATS
What are the dog's favourite activities:
What does the dog dislike/fear:
Where is the dog kept during the day:
Where does the dog sleep at night:
How does the dog travel in the car:
what type of food/food brands do you feed your dog:
Is there anything else that you feel that Pupcakes Rescue and future owners should know about this dog:
Please attach a photograph of your dog:*

Browse Files

Cancelof
Would you be able to bring the dog to the shelter in Boston Lincolnshire yourself or would you require for the Pupcakes coordinators to arrange transport to pick your dog up from your home? (we require that owners cover the petrol cost of the journey made by our volunteer transporter)
Appointments for dogs to be surrendered can be arranged after your application is submitted as well as available dates and costs for pick-up, should your dog be accepted into the care of Pupcakes.
If we have the capability to take your dog into rescue is there any given time frame that you would need your dog relinquished to us or is there capability for you to hold onto your dog until we could potentially make space at a later time? *
Should be Empty:

PUPCAKES RESCUE - OWNER SURRENDER FORM

YOUR DATA