Dog Surrender/Rehoming Form - Rottweiler Rescue

Owners Full Name

Pound or Rescue Name (if relevant)

Address Street & No.

Suburb

City

Postcode

Council

Telephone(Home):

Telephone(Business):

Mobile

Email

1. Dogs Name:

Nicknames:

2. Sex:

Female
Male

3. Age & Date of Birth (approx.)

4. Breeders Name (if relevant)

Papers

Yes
No

5. Spayed/Neutered

Yes
No

6. Docked

Yes
No

7. Microchipped

Yes
No

Microchip number:

8. Microchip Registration -> Animal Companion Register:

Yes
No
Don’t Know

National Dog Database:

Yes
No
Don’t Know

9. Vaccinations Up to Date

Yes
No
Don’t Know

10. Registered

Yes
No

Council Name:

Reg. Number:

11. Reason for Surrender

12. We need to know as much about your dog as possible to ensure a “perfect match” in their new home. -> Good with cats

Yes
No
Don’t Know

Good with other dogs

Yes
No

Details of size etc:

Good with children

Yes
No

If yes give ages exposed to:

Good around elderly

Yes
No
Don’t Know

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

Yes
No
Don’t Know

Is the dog toilet trained?

Yes
No

Any food aggression?

Yes
No

Has the dog ever growled, snapped or bitten anyone?

Yes
No

If Yes please provide details:

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

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

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

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

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

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

18. 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)

21. 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