Animal Care Dog Form Unwanted Dog Form Your details All questions marked with an asterisk are requiredFull Name (Title, first name & last name)* Address* Address City County Postcode Your Email* Your landline telephoneYour mobile telephone*Reason to surrender*Number of dogs being surrendered*Has your dog been imported from outside the UK?* If yes, do you have the Pet Passport and proof of all required vaccines / blood tests?Has your dog ever stayed in a kennels previously? if yes please state frequency and duration.Are they to be rehomed together?* Yes No Is the dog/s microchipped? If yes, is the microchip registered to you?* Yes Yes, registered to someone else No Unknown (please note: if you are not the registered owner we will require a signed letter from the registered owner)Is the dog/s being surrendered on behalf of someone deceased or who is unable to care for the dog any longer?* Yes No (please note: if you cannot attend the appointment to bring your pet in, we will require a signed letter from the registered owner)If Yes, please state the name and address of the registered owner?If your dog came to you from Ferne or another rescue please enter the name of the rescue centre.* please note: if from a different rescue centre, it will need to be returned to them.How long have you owed your dog?* Under 1 month 2 to 12 months 1 year + Dog Details Dog/s Name Breed Colour Gender of dog:* Male Female Neutered* Yes No Unknown D.O.B / Approx. age About your dog Please be completely open and honest, as the more we know the easier it will be for us to find the best possible new home for your dog - we understand how difficult this may be for you but please remember that we are here to help you and your pet.Are there any area of your dogs body that it does not like being stroked* Yes No If selected yes, please provide further information Does your dog get over excited during play (I.e. play bites)* Yes No Is your dog destructive in the home* Yes when left Yes even when someone is home Yes with his own toys No Does your dog bark / howl when left* Yes No Does your dog have any behavioural issues (e.g. separation anxiety, aggression, noise fears)* If yes please give detailsHow many hours is your dog happy to be left on its own and where does it stay during this time?* Is your dog good with adults: Yes No Are there children in your home: Yes No Is your dog good with children: Yes No tolerates them avoids nervous Has it lived with another dog before: Yes No If yes, was it good with the other dog: Yes No Diet & Medical Usual diet (type & brand of food (dry / wet)) Are vaccinations up to date? Yes No Unknown (If yes, please bring vaccination card with you)Date Last Wormed & Name of Product* Date last treated for fleas & Name of Product* Name of Vet surgery currently / previously registered with*Please ask to contact vet to give permission for us to have the vet history.Please use the box below for any further comments:Please provide any information on current or previous health issues and or treatments.