Person providing information *
Owner
Friend
Family
First name *
Surname *
Address *
Suburb *
Postcode *
Best Contact Number *
Email Address *
Owner's reason for surrendering your dog? *
Dogs Name *
What breed is your Dog? *
Sex *
Male
Female
How old is your dog? *
Has your dog been Desexed? *
Yes
No
Unsure
Does your dog have a microchip? *
No Yes
Is the microchip name in your name? *
Yes
No
Unsure
Is your dog up to date with it's annual vaccinations? *
No Yes
Where did you get your dog from initially? *
Personality Description of your dog *
Does your dog have any Anxiety, Medical Issues, Dietary requirements, Behavourial, Aggression issues? Please describe... *
Where does your dog sleep? Please describe *
Please describe your dog's feeding regime - brands of food, scraps, dry or tinned, flavours, feeding times and quantities. Any dislikes? *
What is your dog's reaction if you approach it when it is feeding? *
What kind of fencing do you have? *
6ft Timber Brick or Colorbond - my dog does not escape
6ft Colorbond Fence - my dog can climb
6ft Timber Fence - my dog can climb
4ft Fence - my dog does not jump
Fence needs to have concrete at the bottom as they dig
Wire fencing is fine - they don't climb
Any fence is fine
My dog is hard to contain as they like to escape
I don't have a fence
They prefer to be inside
Does your dog have escaping issues, what have you done to remedy? *
Has your dog lived with other dogs? *
No Yes
If so, please specify age and sex and what their interactions are like. *
Has your dog lived with cats? *
No Yes
If yes, is your dog comfortable with them?
Has your dog lived with animals other than cats and dogs? ie livestock, pocket pets *
No Yes
If yes, please specify the species and their reaction to them. *
Has your dog lived with children? *
No Yes
If so, please specify ages *
Is your dog comfortable around children? Please describe their relationship or concerns *
How does your dog react when he/she has done something wrong? How do you "correct them"? *
Does your dog return when called whilst off the lead? *
No Yes
Is your dog toilet trained? Please describe any toileting issues. *
No Yes
What commands does your dog obey? And what commands are used? For example, sit or sit down; lie or lie down etc. *
Would you describe your dog as a gentle player or does he/she like "rough" play? Describe your animal's play activity, eg. favourite game, favourite toy, etc. *
Does your dog pull on the lead? Do you use Collar, Halti, Gentle Leader? *
Do you leave your dog alone for any period of time? If so, how long for and do you have concerns about them being on their own? Where do you leave them? *
Has your dog ever been destructive in the house or yard? Please describe *
Does your dog have storm/fireworks fear? What do you do to ease it? *
Has your pet caused injury to another animal or person? Please describe.. *
Does your dog travel well in cars? *
No Yes
Photo of your Dog
Owner Signature *
Clear