Rehoming assistance form

Rehoming assistance form – Dog
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail *
Name of the dog you need assistance with rehoming *
Reason you are needing to rehome your dog *
Are you able to assist with transport once a foster home is found? *

Yes, I can assist with transport No, I can not assist with transport
Age and Date of Birth of your dog *

Age DOB
Breed of your dog *
Weight of your dog
Sex of the dog *

Male Female
How long have you owned your dog?
Is your dog friendly with dogs? *

Yes, all dogs Yes, big dogs only Yes, small dogs only No Unsure
Is your dog friendly with cats? *

Yes, all cats Yes, selective No Unsure
Is your dog friendly with children? *

Yes, all ages Yes, older than 10 only No Unsure/untested
Is your dog friendly with chickens and ducks? *

Yes No Unsure
Is your dog an inside dog? *

Inside Only Outside Only Inside & Outside Unsure
Is your dog house trained? *

Yes, all the time Sometimes No Unsure
Does your dog require specific fencing? *

Yes - please see below for details No Unsure
Please describe the type of fencing your dog requires
Does your dog have any behavioural issues? (In particular, please note any aggression they have exhibited towards humans or other animals & any anxiety issues they have shown, including storm and separation anxiety) *

Yes - see below for details No Unsure
Please describe your dog's behavioural issues in as much details as possible
Does your dog have any medical issues? *

Yes - see below for details No Unsure
Please describe type of medical issues your dog has
Has your dog had any vetwork done? Please select all that are applicable from the list below. *

Desexed Microchipped Vaccinated (in the past year) Worm treatment monthly Flea & tick treatment monthly Heartworm prevention up to date All of the above None of the above
Please provide name and dates of above flea, worm & tick treatments (Eg: Nexgard Spectra 01 July 2017)
Date of last known vaccination

Month Day Year
Please upload a copy of the vaccination certificate (if available)
Microchip number
Do you consent to HT contacting your vet for your pets history?

No I do not I don't have a regular vet Yes I do (please write name of vet below)
How urgent to you require assistance? *

Very urgent - within a week Moderately urgent - within two weeks Not urgent I have a deadline (please type date you need the dog rehomed in other box below)
Where did you originally source your dog from? *

A registered breeder Unregistered breeder Gumtree Pet store Facebook A gift RSPCA AWLQ Happy Tails Animal Rescue a rescue group
Additional comments
Photo of your dog (clear, front on are best)
Photo of your dog (clear, front on are best)
Photo of your dog (clear, front on are best)
Please sign ownership of your animal to Happy Tails Animal Rescue Inc. *

Clear
Should be Empty:

Rehoming assistance form – Dog