SURRENDER FORM

Please answer all of the questions below to the best of your ability

* Indicates required field

Name *

First

Last

Email *

Home Number *

Mobile Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Please attach a copy of your current Drivers Licence, front and back OR pictured identification please *

Max file size: 20MB

Upload another file (optional) *

Max file size: 20MB

It is accepted that the above named person surrenders to Bull Terrier Rescue Australia Inc. a canine described as follows:

Name *

Age *

Sex *

Colour/Markings *

Microchip # *

Desexed? *

Heartworm Treatment Due? *

Worming Due? *

C5 Vaccination due? *

Date of vet health check (must be within 14 days of today) *

Pedigreed with papers? *

Have you contacted the breeder? *

Bred By *

Breeders Phone number *

The following questions are to assist the Rescue and our Carers to make the transition into the new environment as easy as possible for your dog. The more we understand about your dog, the easier it will be for us to place him / her

1. Please tell us a little about your Bull Terrier, how long you have owned your dog & why you are rehoming Him / Her *

2. Does your dog get along with other animals? If so which animals? If not, please describe how they react when meeting another animals. *

3. Is your dog dominant or submissive with other dogs? Does your dog prefer other males/females dogs. *

4. Is your dog prey driven? Do they want to chase cats, small dogs or other small animals? *

5. How does your dog react when meeting new people, are they friendly, relaxed, boisterous, anxious, aggressive? *

6. Does your dog have a particular preference for men or women & how do they behave around children? *

7. Does your dog growl or bark when you have visitors. Are they protective of you, your vehicle or your property. *

8. Has your dog had any obedience training, can they sit, stay, drop, wait for meals etc? *

9. Does your dog walk well on the lead or does he / she pull? When off the lead, does your dog have good recall. *

Does your dog travel well in the car *

11. Is your dog used to going in public places, if so how does he / she behave? *

12. Does your dog show any signs of food aggression? Are you able to remove a food bowl or a bone from your dog? *

13. Is your dog possessive over food or toys? Will your dog allow another dog near his / her food or toys? *

14. If your dog lives with another animal what is their routine at feed time? *

15. What do you feed your dog and how often, at what time of day? *

16. Does your dog have any special dietary requirements? *

17. Does your dog have any health issues or medical requirements? *

18. Does your dog sleep inside or outside, where are they used to sleeping *

19. Is your dog housetrained? *

20. Is your dog crate trained? *

21. Has your dog ever been kennelled? *

22. How many hours a day is your dog used to being alone? *

23. Where is your dog kept when you are out? *

24. Does your dog have separation anxiety? If so what form does this take? *

25. Does your dog bark or become destructive when left alone? *

26. Are you able to provide care for your dog until an alternative home is found *

Has this dog EVER bitten anyone, human or animal? If so please describe the incident. *

Anything else you would like to let us know about your dog? *

Vaccination Certificate from Vet Clinic *

Max file size: 20MB

Vet History Report from Vet Clinic *

Max file size: 20MB

Certificate of desexing (if applicable) *

Max file size: 20MB

Microchip Transfer Form *

Max file size: 20MB

I hereby certify that I am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this Animal Surrender Form, hereinafter referred to as “the animal/canine” I hereby surrender any and all property rights to the animal. I certify that no other person has a right of property to this animal. I understand that by surrendering my property rights to the animal, the animal is transferred into the custody of Bull Terrier Rescue Australia Inc. I also hereby certify that all of the answers to the above form are true to the best of my knowledge. I understand that once I relinquish the animal, the animal will not be available to be returned. I further certify that I have read and understand these terms of this Animal Surrender Agreement.

I agree with the above statement *

Yes I have uploaded my signature confirming that the information on this form is true and correct and I agree to the terms and conditions.

Upload signature *

Max file size: 20MB

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