EmailMe Form - Dog or Puppy Surrender Form

Dog or Puppy Surrender Form

We appreciate you providing us with as much information as possible, so we are able to understand and care for the dogs as best as we can.
Please give as much detail as you can so that we can understand your dog’s routines, habits and the environment they’ve been living in.
Please also note that whilst every attempt is made to house your dog with a CRQ foster carer, there may be a time that a carer is not available. We always have your dog’s best interest at heart and for this reason we have teamed up with a few trusted affiliate Rescues whom we may contact to place your dog within their group. Please rest assured that at no time will your dog be left uncared for. We work closely with these rescues to make sure all your dog’s needs are met.

Owners Name *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Mobile or Best Contact Number *
Email
Dogs Name *
Date of Birth or Age *
Sex *
Male
Female
Primary Breed *
Colour/Markings
Is your dog desexed? *
Yes
No
Not sure
Is your dog vaccinated? *
Yes
No
Not sure
Date vaccination given:
Is your dog microchipped? *
Yes
No
Not sure
If yes please add microchip number:
Is your dog on heartworm prevention? *
Yes
No
Not sure
Date heartworm prevention given:
Is your dog worm and flea treated? *
Yes
No
Not sure
Date worm and flea treatment given:
People living at your premises: *
Adults
Children
Number of children and their ages:
Where type of housing do you live in? *
House
Townhouse
Apartment
Rural Setting
Do you Work? *
Part time
Full Time
Retired
Student
Not working
Work From Home
How long have you had your dog? *
Where did you get your dog from? (Pet shop, breeder, rescue, online etc.)
Is your dog used to living with other animals? *
Yes
No
If so, what species? *
Other small dogs
Large dogs
Cats
Chickens
Other
Do you believe your dog is safe around adults? *
Yes
No
Do you believe your dog is safe around children? *
Yes
No
Do you believe your dog is safe around small dogs? *
Yes
No
Do you believe your dog is safe around cats? *
Yes
No
Do you believe your dog is safe around big dogs? *
Yes
No
Does your dog display any of the following behaviours? *

Excessive Barking

Destructive Behaviour

Serial Escaping

Separation Anxiety
Has your dog had any training?
If yes please specify:
Is your dog toilet trained *
Yes
No
Where does your dog sleep *
Inside
Outside
Reason for surrendering your dog to Chihuahua Rescue Qld Inc. *

Excessive Barking
Destructive Behaviour
Serial Escaping
Separation Anxiety

Does your dog regularly see a veterinarian? *

Vets Name
Vets Contact Details
Does your dog have any past or present medical conditions?
Is your dog currently on any medications? If yes, please describe medication, reason and dosage.
Any Other Comments:

Upload scans of Vet History
Upload a photo of your dog
1) 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.

2) I hereby surrender all rights, title and interest in the said animal to CHIHUAHUA RESCUE QLD Inc., and agree that the said animal will become the sole and absolute property of CHIHUAHUA RESCUE QLD Inc. which is hereby authorised to hold, foster, and rehome this animal at their discretion.

3) I certify that no other person has a right of property to the animal

4) I understand that once I relinquish the animal, the animal will not be available to be returned.

5) I declare the above information to be true and correct to my knowledge and I understand it is an offence to provide false or misleading information and that I can be held liable.

Name: *
of Address: *