Surrender Form Surrender FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please answer as honestly as possible. If we later find things have been omitted from your form, we may refuse to help with rehoming your dog. Honest answers ensure that we get the best possible home for your dog. We do ask for a copy of your ID and a photo of a recent bill so that we can confirm the details on the microchip. Please also be aware that your details may be passed to a third party volunteer organisation who help us when we don’t have our own volunteers available. Please select the title that best suits you *MrMrsMissMsOtherFull name *FirstLast treatment Vet in Address *Address Line 1CityState / Province / RegionPostal CodeEmail *Contact number *What is your preferred method of contact?EmailSMSPhoneWhatsAppWhat time is best to contact you?MorningAfternoonEveningAnytimePlease upload the following items Copy of passport or driving licence A photo of a utility bill dated within the last 3 months Photos of your dog Any records for your dog such as medical history etc. Please upload here * Drag & Drop Files, Choose Files to Upload You can upload up to 20 files. Are you pursuing any other methods to rehome your dog? *Friends/FamilyOther rescuesOtherDog's name *Dog's age *Dog's breed *Sex *Colour *Neutered/spayed *YesNoIf not spayed, when was last season?Microchip No. *The dog must be registered to the person submitting the rehoming formFull or docked tail? *FullDockedHow long have you owned your dog? *In this next section we kindly ask that you include everything your dog has ever been to the vet for no matter how insignificant this is (excluding flea and worm treatment and vaccinations). This helps us enormously where there have been behaviour issues and experience has shown that where a dog has suddenly become aggressive it is due to health problems that were flagged up but seemed to put themselves right or a flare up of a pre-existing condition. Does your dog suffer from any ongoing health issues? *Is your dog currently receiving any medications? *If yes, please give detailsAny known allergies or dietary needs? *Date of last flea treatment *Date of last worm treatment *Date of last vaccination *Vaccination certificate available? *YesNoHas your dog been vaccinated for kennel cough? *YesNoVet details *Address Line 1Address Line 2CityState / Province / RegionPostal CodeVet contact number *Vet email *When was your dog last seen by a vet and what for? *When did your dog last have a health check? *How is your dog with other dogs? *How is your dog on lead? *How is your dog off lead? What is their recall like? *How often is your dog walked and for how long? *Will your dog sit/stay on command? *Is your dog tolerant of cats? *Has your dog ever attacked another animal? *Has your dog ever attempted to attack another animal? *Has your dog ever bitten a person? *Has your dog ever attempted to bite a person? *How is your dog with other animals in the home? *e.g. rabbits, hamsters, guinea pigsWould you consider your dog to suffer from separation anxiety? *Can you leave you dog unattended in the home? *If so, for how long? Can your dog be trusted not to chew?Has your dog been brought up with children? *If so, what ages and how does the dog get along with them?How is your dog with toys? Happy to share or guards? *Does your dog dig? *YesNoDoes your dog jump fences? *YesNoIs your dog housetrained? *YesNoIs your dog cratetrained? *YesNoDoes your dog bark a lot? *YesNoDoes your dog sleep inside or outside? *InsideOutsideHas your dog ever been left in kennels? *YesNoDoes your dog travel well in the car? *YesNoWhat is the longest journey your dog has been on in the car? *How does your dog travel in the car? e.g. in a crate, harness attached to seatbelt, harness attached to headrest *How is your dog when strangers visit your home? *How is your dog with strangers outside the home? *How is your dog when being groomed? *How is your dog at the vet? *Is your dog frightened by loud noises, traffic or fireworks? *Does your dog have any of the following issues?Jumping upChewingFear of objectsFear of other animalsLicking feetScratching skin/earsShaking headHas your dog previously been rehomed? *YesNoHas your dog ever been seen by a behaviourist? *YesNoThird ChoiceWould you be prepared to work with one of our behaviourists to keep your dog in your home? *YesNoMaybeBehaviourist detailsPlease give contact detailsPlease upload behaviourist's report Drag & Drop Files, Choose Files to Upload What brand of dog food do you feed your dog? *How many times a day/what times?How much? *Will any food be handed over with dog?Will any possessions be handed over with dog? (If possible, it would be nice for your dog to have its bed or blanket handed over with it). Please list *If your dog sleeps in a crate, will this be given to the adopter and if so, what size is the crate?Please outline why you are looking to rehome your dog, including any details regarding a bite history if there is one. (We are not here to judge; we simply want to know how we can best help your dog)I confirm that The details I have provided are true to the best of my knowledge and I have not concealed any details regarding the safety or health of my dog I agree to my contact details being used as part of the fostering process I understand that submitting this form does not constitute an agreement to rehome my dog until I am provided with, and sign, a Surrender Form The dog on this form is not subject to any ownership disputes or legal proceedings and the microchip is registered to me I understand that UK Spaniel Rescue reserves the right to share pictures of my dog on social media Please note, we must have a copy of the medical history and the microchip number for the dog before we can consider rehoming. I give UK Spaniel Rescue my permission to contact my veterinary practice to obtain medical records for my dog *YesNoSignature Clear Signature Date Where did you hear about us? *©UK Spaniel Rescue 2024 Copyright Notice Submit
