Rehoming assistance form – Dog
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Home address
*
Which suburb is the dog located?
*
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
Date Picker Icon
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
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
Submit
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