First Name
Surname
Address
Address Line 1
City
County
Post Code
Contact Phone Number
*
Email Address
*
Other than the person detailed on this form are there any other legal owners of the dog who should be advised of this request to be rehomed?
*
Please Select
Yes
No
Please give details
Name of dog:
*
Age of dog:
*
Sex of dog:
*
Please Select
Dog
Bitch
Is dog a Giant Schnauzer cross:
*
Please Select
Yes
No
Please give details
Is dog microchipped:
*
Please Select
Yes
No
Is dog neutered or spayed:
*
Please Select
Yes
No
If entire bitch please give approx. date of last season:
If entire bitch has she ever had pups?:
*
Please Select
Yes
No
Pregnant
Please give details
Is dog in date for annual vaccinations:
*
Please Select
Yes
No
Is dog insured?
*
Please Select
Yes
No
When is annual booster due?
Reason for rehoming dog?
How long have you owned this dog?
*
Where did this dog come from?
*
Please Select
From breeder
From rescue
Private rehome
From family member or friend
Please give further details
Have you had this dog from pup?
*
Please Select
Yes
No
Is dog used to living with another dog?
*
Please Select
Yes
No
Please give further details
Is dog used to living with a cat?
*
Please Select
Yes
No
Please give further details
Is dog used to living with children?
*
Please Select
Yes
No
Please give further details
*
Is dog housetrained?
*
Please Select
Yes
No
How long is dog comfortably used to being left for?
*
Not left
1-2 hours
2-3 hours
3-4 hours
More than 4 hours
Separation anxiety
*
Please Select
Yes
No
Food aggression
*
Please Select
Yes
No
Toy aggression
*
Please Select
Yes
No
Anxious of strangers (inside home)
*
Please Select
Yes
No
Anxious of strangers (outside home)
*
Please Select
Yes
No
Reactive to other dogs (outside home)
*
Please Select
Yes
No
Reactive to cats (outside home)
*
Please Select
Yes
No
Mouthing
*
Please Select
Yes
No
Does your dog bark excessively?
*
Please Select
Yes
No
Please give further details
Has your dog ever bitten (not puppy mouthing)?
*
Please Select
Yes
No
Please give further details
Does your dog pull on lead?
*
Please Select
Yes
No
Please give further details
Does your dog have good recall when off lead?
*
Please Select
Yes
No
Please give further details
Has your dog ever been to training classes?
*
Please Select
Yes
No
Please give further details
Does the dog have any medical conditions we need to be aware of? (allergies / travel sickness etc)?
*
Please Select
Yes
No
Please give further details
Is your dog registered with a vet?
*
Please Select
Yes
No
Please give further details
Have you contacted any other rescues to rehome your dog?
*
Please Select
Yes
No
Please give further details
Do you have a vehicle to transport your dog to rescue?
*
Please Select
Yes
No
Does your dog travel well in car?
*
Please Select
Yes
No
Please give further details
Additional info you may wish to include:
Comments
Please verify that you are human
*
Submit
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm