Dog Surrender/Rehoming Form

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This form is to ensure we get your official permission to re-home your dog. It also allows us to find out as much as we can about your dog to ensure the best match in a new home.

Whilst we will do everything possible to find a home for your dog we can’t guarantee the perfect home will come along immediately. Please be aware of this. We prefer the dog stays with the current owner until a new one is found. If you can’t keep the dog please let us know.

Please ensure that you complete the form in full and include all relevant information. Failure to do so will result in a delay in rehoming your dog. Completion of this form does not signify acceptance of your dog for rehoming. We reserve the right to refuse any dog for rehoming and will not enter into any correspondence on our decision.

"*" indicates required fields

Your details

Owners Full Name*

Pound or Rescue Name (if relevant)

Address*

Street Address Address Line 2 City Region Post code

Telephone(Home):

Telephone(Business):

Mobile:

What council are you in?

Information about the dog

Dogs Name:*

Nicknames:*

Sex:*

Female

Male

Age / Date of Birth (approx.)*

Breeders Name (if relevant)

Papers?*

Yes

Spayed/Neutered*

Yes

Docked*

Yes

Is the dog microchipped?*

Yes

Microchip number:

Microchip Registration -> Animal Companion Register:

Yes

I don't know

National Dog Database:

Yes

I don't know

Vaccinations Up to Date*

Yes

I don't know

Registered*

Yes

I don't know

Reg. Number:*

11. Reason for Surrender*

The dog's behaviour

We need to know as much about your dog as possible to ensure a “perfect match” in their new home.

Good with cats*

Yes

I don't know

Good with other dogs*

Yes

I don't know

Good around livestock e.g. cattle, sheep, goats, chickens*

Yes

I don't know

Good around elderly*

Yes

I don't know

Good with children*

Yes

I don't know

What age children has the dog been exposed to?*

Details of size etc:

Any food aggression?*

Yes

Is the dog toilet trained?*

Yes

Has the dog ever growled, snapped or bitten anyone?*

Yes

Please provide details:*

More info about the dog

Where does your dog currently sleep? Inside or outside? Please specify whether in kennel, crate or on own bed.*

What do you currently feed your dog? Please name brands, amount and frequency.*

Which areas of the house has the dog been exposed to? E.g. is it allowed inside or always outside?*

How many hours has the dog been without human company for each day?*

How often have you been exercising your dog? How long for? On lead or off lead?*

Please tell us as much as you can about your dog. Likes, dislikes, bad habits etc

Local Council -> I agree to a council background check being conducted*

Yes (please tick/check box)

19. My local vet the dog is registered with -> Vet Clinic Name:

Address:

Contact Number:

Does the dog have any health issues/conditions:

Is the dog on any medication? If so, please list here:*

20. Surrender Fee
Due to the cost of rehoming a dog we do request a fee to assist us in the rehoming process. Please note that this fee will not be due until your dog has been accepted for rehoming.

Minimum Donation: $50.00

Additional Donation:

Total to Pay:

Payment can be made directly to:
Rottweiler Rescue
01-0281-0638309-00
Reference: Dogs Name (e.g. Bella)

Other information you wish to provide.

By submitting this application, I hereby agree that all the information I have provided is correct. I agree that I am the registered owner of this dog and have the legal right to rehome the above-mentioned dog.
Providing untruthful answers or failure to comply with the requirements of this application can result in us being unable to rehome your dog.
You agree to allow us to check with your local council and veterinary clinic for information as may be required.
We appreciate you taking the time to complete this form. Upon review and approval, we will contact you as soon as possible.
We do charge an adoption fee but do not pay to take a dog.
Please note that Rottweiler Rescue & Rehoming NZ takes no responsibility or liability for any damage or injury the dog may cause to property or persons. While every care is taken to ensure the temperament of the animal they can have issues. Please be aware of this when signing the form.
We reserve the right to refuse any dog for rehoming and will not enter into any further correspondence on our decision.

Name and Signature:

Date

MM slash DD slash YYYY

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