First Name

Last Name

Email address

Please confirm your email address

Address

Suburb

Postcode

State StateAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia

Phone

Your dog's name

Your dog's Date of Birth (or age if DOB not known)

Your dog's microchip number

Dog's Gender Dog's Gender Male Female

Your dog's breed or mix of breeds

Why do you need to re-home your dog? Please be specific and give as much information as possible.

How long have you owned your dog?

Where did you get your dog from?

If your dog is from a registered breeder, please list their name, kennel prefix or contact details.

How much does your dog weigh? (please do not guess)

Is your dog desexed? Is your dog desexed? Yes No

If yes, please email a copy of a desexing certificate which has been signed by your vet to contact@arcticrescue.org.au

The date your dog was last vaccinated

The date your dog was last treated for heartworm

The date your dog was last treated for fleas

The date your dog was last treated for intestinal worms

List any medical issues your dog has/is experiencing

Has your dog lived with other dogs now or in the past? If yes please list breeds and ages

Has your dog lived with cats? If yes, please describe their interaction.

Has your dog been around any pets or animals other than dogs or cats? If yes, please detail the types of animal and your dog's interaction.

Does your dog regularly socialise with other dogs outside of your home? If yes, please describe their interaction.

What areas does your dog have access to when you are home? (please select all that apply) What areas does your dog have access to when you are home? (please select all that apply) All areas inside Some areas inside Outside

And when no one is at home? (please select all that apply) And when no one is at home? (please select all that apply) All areas inside Some areas inside Outside Other

Where would your dog sleep at night? Where would your dog sleep at night? Inside Outside Either inside or outside

On average, how many hours would your dog be without human company each day?

What are you feeding your dog and how often?

How often do you walk your dog on average?

How long are your walks on average?

Do you walk your dog on or off the lead? Do you walk your dog on or off the lead? Always on lead Mostly on lead, but off lead in secure areas On or off lead in any public area

Briefly describe your dog's energy levels, play styles and likes & dislikes of other dogs.

Has your dog ever shown any aggression towards another dog? If yes, please describe the circumstances and level of aggression.

Briefly describe how your dog reacts to children.

What is the range of ages of the children your dog has interacted with?

What type of training have you done with your dog?

What is your dog like to walk on lead?

Under what circumstances does your dog bark or howl?

Has your dog ever shown any type of aggression towards people? If yes, please describe the level of aggression and circumstances.

Does your dog guard food, water, bowls, toys or any other items? If yes, please describe the guarding behaviour.

Has your dog ever escaped? If yes, how did your dog get out, how often has he/she escaped, and what were the circumstances?

Does your dog dig? If yes, please describe the extent of the digging.

What, if anything, makes your dog nervous or frightened?

What does your dog enjoy?

Please write a brief profile of your dog for advertising purposes:

Is there anything else you would like to tell us about your dog?

If we do not have a foster home available, are you able to keep your dog until a new home can be found? If not, please explain your circumstances.

Is the dog registered in your name? If not, whose name is the dog registered in?

Which council is your dog currently registered with?

What is your dog's council registration number and date of last renewal?

I confirm that I have the authority to surrender this dog, and have answered all questions truthfully and to the best of my knowledge. I confirm that I have the authority to surrender this dog, and have answered all questions truthfully and to the best of my knowledge. Yes No

PLEASE NOTE: The form will not submit if any of the required fields are not filled in.