Surrender form

*Required information.

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Please answer all questions fully as this information helps us to re-home your dog in a suitable environment and please remember it is in your dog’s best interests to be honest as it is very unsettling for a dog to be passed from home to home due to mis-information. PLEASE NOTE: We require at least two different photos of the dog. These will need to be attached to the form below. Please do not start filling in the form until you have the photos ready. We must have photos of the dog before we can proceed with rehoming.
Dog's details
Name *
Breed *
Age *
Gender * Male Female
Approximate weight (kg) *
Approximate height to the shoulders or back of neck (collar) *
Where did you get the dog from & what age were they? *
What do you know of your dog's prior history? *
What is the dog currently fed on? *
Where does the dog sleep (room and place)? *
What is the dog's current daily routine? *
What is the reason for rehoming? Please give as much information as possible. *
Owner's Details
Name *
Address (including postcode) *
Telephone (mobile and landline) *
Email
Family make-up i.e number of parents and children etc (incl ages) *
Behaviour with other dogs
Do you have any other dogs in the home (including regular visitors)? If yes please provide details below (breed, sex, age & whether neutered).
Dog 1
Dog 2
Dog 3
Is the dog you are looking to re-home good with other dogs in the home (resident or visitors)? If not please provide full details
Is the dog you are looking to re-home good with other dogs outside of the home?If not please provide full details.
Has the dog ever bitten another dog? If yes please give full details or circumstances and specify if any veterinary treatment was required for either dog.
Health
Is the dog vaccinated? * Yes No Unsure
When are vaccinations next due? *
Is he/she spayed/neutered and when was this done? *
Is the dog regularly treated for worms and fleas? If yes what do you use and when were they last treated? *
Is the dog microchipped? * Yes No Unsure
Has the dog had any illnesses? If yes provide details. *
Has the dog had any operations? If yes please specify what and when. *
Is the dog insured? * Yes No
Is the dog currently on any medication? If yes please specify. *
Does the dog have any allergies? If yes please specify. *
If your dog is not spayed or vaccinated are you prepared to pay to have this done? Please be aware that it is rescue policy that all dogs are neutered/spayed and vaccinated prior to finding new homes. As a charity we rely solely on donations to pay for these procedures, so if you are unwilling to fund the costs it may affect our ability to take your dog. *
Your vet details *
Training and Behaviour
Is the dog house trained? *
Is the dog good in the car? *
Does the dog guard toys/food? *
Is the dog crate trained? *
Is the dog good off lead? *
Does the dog know any commands? If so please specify. *
Can the dog be groomed? *
Is the dog good with children? If not please elaborate. *
Is the dog good with strangers? If not please elaborate._Copy *
How is the dog at the vets? *
Does the dog live with cats or any other animals? If yes please give details. *
If they don't live with cats what is their usual reaction to seeing them? *
Is the dog excitable? Is or has the dog ever been destructive or chewed things they shouldn't (beyond puppy stage)? If yes please give details. *
How often and for how long is the dog usually left alone? When left alone do they whine, bark, are destructive etc? *
Does the dog dig in the garden? *
Has the dog ever bitten anyone? If yes please give full details or circumstances and treatment required. *
Is the dog vocal? *
Is the dog a jumper? *
Is the dog an escape artist or do they generally respect doors and boundaries? *
Any special likes/dislikes? *
Please add nny other useful information here. *
Can you please confirm that you have, or will obtain copies of the dog's vaccination card? * Yes No
Can you please confirm that you have, or will obtain copies of the dog's microchip paperwork? * Yes No
How did you hear about Epsom Canine Rescue?
Photos Please attach two clear photos of your dog, preferably one head and one full body shot. If you are unable to attach them, they can be emailed to nikki@epsomcaninerescue.co.uk (stating 'Surrender' and the dogs name in the subject).
Photo 1 (maximum size 2 mb) *
Photo 2 (maximum size 2 mb) *

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