2019 - Rehoming Questionnaire CARD

1
How it Works

Dog Adoption offers a simple, reliable and safe program to help you place your pet from your loving home directly to another.

Learn more about the Rehoming Program
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Importantly, you maintain full control about where your dog is finally placed because:

you are never forced to surrender your dog to us and

you can withdraw your dog at any time if you choose to keep it.
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It is extremely hard to rehome your own dog as objectivity is compromised, especially when mixed with emotions, work and family pressures - or simply being time poor.

If done correctly, screening is extremely time consuming (sometimes 30 hours or more) and requires experience, IT skills, access to back ground evidence and insight.
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NEVER Rehome Your Own Dog By Yourself

Scammers are smooth, persuasive and well rehearsed.

Meeting someone once in a park is NOT enough, no matter how nice they seem.

'Going it alone' risks pitfalls and dangers including:

dog fighting rings,

on-selling,

bonded pairs being separated,

never to sleep inside again,

surrendered to a pound or shelter if the placement fails,

being told what you want to hear and not the truth,

a dominant family member you never met overides the wishes of the person who made promises to you.

Click here to learn more.
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Read Reviews Live
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Do you have a deadline?
Yes
No
7
Unfortunately, the Dog Adoption rehoming program is not designed for people with deadlines.

We recommend you contact a registered charitable shelter or rescue as they receive funds from the community for emergencies.

Regrettably, you may need to surrender your dog(s), have limited say in the placement and have varying safe gudards if the placement fails - as this sector is not regulated.
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The admin fee is $360. Would you like to proceed?* This field is required.Dog Adoption does not make a profit from this service.
Yes
No
9
As an approved Social Enterprise, Dog Adoption does not make a profit - we are self funded.

Learn more

If you require financial assistance please contact a registered charitable rescue or shelter as they receive funding from the community for emergencies.

Regrettably, you may need to surrender your dog(s), have limited say in the placement and have varying safe gudards if the placement fails - as this sector is not regulated.
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Today's Date* This field is required.
Date
Day
Month
Year
11
Name of owner* This field is required.
First Name
Last Name
12
Name of Co-owner
First Name
Last Name
13
Owner's Address* This field is required.
Street Address
Street Address Line 2
Suburb
State
Postcode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
14
Mobile * This field is required.Primary
15
MobileSecondary
16
Phone NumberOptional
Area Code
Phone Number
17
Email * This field is required.Primary means of communication
example@example.com
18
Secondary Email Optional
example@example.com
19
Number of dogs and homes* This field is required.
One dog that needs a new home
Two dogs to be rehomed together (one home)
Two dogs to be rehomed into two homes
Other
20
Administration Fee PayableNon refundable
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Name of dog* This field is required.
22
Name of dog #2* This field is required.
23
Gender* This field is required.
Male
Female
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Gender #2* This field is required.
Male
Female
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Date of Birth* This field is required.
26
Date of Birth #2* This field is required.
27
Breed* This field is required.
28
Breed #2* This field is required.
29
Kgs
30
Kgs #2
31
As copies of vet paper work will be given to the new owner you may like to remove personal information e.g. address.

Please do not edit any details about your dog(s).
32
Microchip* This field is required.
Yes
Yes, but need time to find it
No
33
As of July 2019, it is a legal requirement in most parts of Australia to include the Microchip number for dogs listed for adoption or sale. Please contact us again once you have the microchip number.
34
Microchip number
35
Microchip registry
36
Microchip #2* This field is required.
Yes
Yes, but need time to find it
No
37
As of July 2019, it is a legal requirement in most parts of Australia to include the Microchip number for dogs listed for adoption or sale. Please contact us again once you have the microchip number.
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Microchip number #2
39
Microchip registry #2
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Sterilised?* This field is required.
Yes
Yes but can't find paper work
No
41
Unfortunately, Dog Adoption cannot rehome an unsterilsied dog unless a vet has confirmed in writing it would be unsafe or unhealthy to do so. Please email the authorisation to alyson@dogadoption.org.au and we can send you a new rehoming form.
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Sterilisation Certificate
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Sterilised #2 ?* This field is required.
Yes
Yes but can't find paperwork
No
44
Unfortunately, Dog Adoption cannot rehome an unsterilsied dog unless a vet has confirmed in writing it would be unsafe or unhealthy to do so. Please email the authorisation to alyson@dogadoption.org.au and we can send you a new rehoming form.
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Sterilisation Certificate #2Must be signed and on vet clinic letterhead
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Will vaccination injection (C3) expire within 3 months of adoption?* This field is required.
No
No, but can't find paperwork (refund payable on receipt of vaccination certificate current within 3 months of adoption)
Yes
Maybe
47
Vaccination Payment Due
48
Vaccination CertificateMust be signed and on vet clinic letterhead
49
Will vaccination injection (C3) expire within 3 months of adoption #2?* This field is required.
No
No, but can't find paperwork (refund payable on receipt of vaccination certificate current within 3 months of adoption)
Yes
Maybe
50
Vaccination Payment due #2
51
Vaccination Certificate #2Must be signed and on vet clinic letterhead
52
Intestinal Worm Prevention?
Please Select
Please Select
Yes
No
Is worming current?
If YES, list when next due and if administered monthly or 3 monthly.
53
Intestinal Worm Prevention #2?
Please Select
Please Select
Yes
No
Is worming current?
If YES, list when next due and if administered monthly or 3 monthly.
54
Heart worm prevention injection current?* This field is required.Annual injection if applicable. Optional.
Yes
No
55
Heart worm prevention injection certificateOptional. Must be signed and on vet clinic letterhead
56
Heart worm prevention injection current #2?Annual injection if applicable. Optional.
Yes
No
57
Heart worm prevention injection certificate #2Optional. Must be signed and on vet clinic letterhead
58
Prescription medications or medical issues.
Include name if re-homing 2 dogs
0/60
59
Serious behavioural issues.
Issues new owners need to know
0/60
60
Registered with local council?Optional
Yes
No
61
Shire
62
Registration number
63
Registered with local council #2?Optional
Yes
No
64
Shire #2
65
Registration number #2
66
Ever bitten a person?* This field is required.
Yes
No
67
Was medical attention required?
Yes
No
68
DetailsIf applicable
Include name if rehoming 2 dogs
0/60
69
Ever attacked another dog?* This field is required.
Yes
No
70
Was vet treatment required?
Yes
No
71
Did the attack result in the death of a dog?
Yes
No
72
DetailsIf applicable
Include name if rehoming 2 dogs
0/60
73
Been declared a 'dangerous dog' by authorities?* This field is required.
Yes
No
74
DetailsIf applicable
Include name if rehoming 2 dogs
75
Where did you get your dog?
Pet Shop
Breeder
Rescue
Paper / Gumtree etc..
Pound
Other
76
Where did you get your dog(s)?
Rescue
Breeder
Pet Shop
Private adoption
77
Do you want to involve the breeder or rescue?
Yes
No
78
Name and contact details of the breeder or rescue.
79
Regarding OTHER dogs, your dog is:* This field is required.Select all applicable
good (social and friendly) with other dogs
wary of unfamiliar dogs but is not aggressive
good with other dogs unless my dog is on a lead
good with other friendly dogs at home but unsocial when out
good with other dogs the same gender
good with other dogs the same size or smaller
protective - will warn other dogs who come close to back off
enthusiastically rushes into another dog's space wanting to say hello in a friendly manner
won't usually start an altercation but won't back down if challenged by another unfriendly dog
pulls and battles to get free and is likely to attack another dog
80
Regarding OTHER dogs, your #2 dog is:* This field is required.Select all applicable
good (social and friendly) with other dogs
wary of unfamiliar dogs but is not aggressive
good with other dogs unless my dog is on a lead
good with other friendly dogs at home but unsocial when out
good with other dogs the same gender
good with other dogs the same size or smaller
protective - will warn other dogs who come close to back off
enthusiastically rushes into another dog's space wanting to say hello in a friendly manner
won't usually start an altercation but won't back down if challenged by another unfriendly dog
pulls and battles to get free and is likely to attack another dog
Other
81
DetailsOptional
Situations where dog is anti social, anxious, territorial, reactive etc.. Include name if rehoming 2 dogs .
0/60
82
Proven to live safely with cats within the last 3 months?* This field is required.
Yes
No
Depends
83
Proven to live safely with cats within the last 3 months #2?* This field is required.
Yes
No
Depends (please provide clear details below)
84
DetailsOptional
e.g. lives in harmony, prickly, certain conditions etc...
0/60
85
Trusted around kids?* This field is required.
Yes
No
86
Trusted around kids #2?* This field is required.
Yes
No
87
DetailsOptional
e.g. defensive of food, may knock a small child over, is frightened of noise etc...
0/60
88
Exercise requirements
Super low - prefers to be carried.
Low - short strolls or playtime at home.
Medium - playful and moderately active.
High - will run and run, cannot miss a day.
Other
89
Exercise requirements #2
Super low - prefers to be carried.
Low - short strolls or playtime at home.
Medium - playful and moderately active.
High - will run and run, cannot miss a day.
Other
90
Details
0/30
91
When walking on the lead:
is well behaved
starts off pulling but settles
ok unless distracted
pulls and battles
Other
92
When walking on the lead #2:
is well behaved
starts off pulling but settles
ok unless distracted
pulls and battles
Other
93
Details
e.g. may pull a small person over etc..
0/60
94
When OFF the lead:
Stays close by and comes when called.
Sometimes good and sometimes bad.
Takes off and won't come back.
Other
95
When OFF the lead #2:
Stays close by and comes when called.
Sometimes good and sometimes bad.
Takes off and won't come back.
Other
96
Details
0/30
97
Toilet Trained?* This field is required.
Yes
No
Other
98
Toilet Trained #2?* This field is required.
Yes
No
Other
99
Barking* This field is required.Select all applicable
Quiet - rarely makes a sound.
Will alert to something strange but is not currently a nuisance barker.
Barks a lot but can be commanded to stop.
Barks when alone.
Barks all the time.
Other
100
Barking #2* This field is required.Select all applicable
Quiet - rarely makes a sound.
Will alert if something strange but is not currently a nuisance barker.
Barks a lot but can be commanded to stop.
Barks when alone.
Barks all the time.
Other
101
Fencing* This field is required.Select all applicable
May take advantage of an open gate and wander off but does not usually try and escape
Will dart through an open gate or door and take off
Does not need fencing as never wanders off
Ok with shoulder height fencing
Requires 6' (2 meter) high fencing
Will dig underneath if able
Will use foot holds to climb e.g. trellis, wire
Needs an enclosed dog run including a roof
Other
102
Fencing #2* This field is required.Select all applicable
May take advantage of an open gate and wander off but does not usually try and escape
Will dart through an open gate or door and take off
Does not need fencing as never wanders off
Ok with shoulder height fencing
Requires 6' (2 meter) high fencing
Will dig underneath if able
Will use foot holds to climb e.g. trellis, wire
Needs an enclosed dog run including a roof
Other
103
Destructive?
0/60
104
My dog(s) like, dislike, fear ...
0/60
105
During the day my dog(s) require:* This field is required.Select all applicable
someone home more often than not.
stay at home parent.
someone that works from home.
part time workers.
empty nesters.
active retirees.
full time workers (9am-5pm) as long as my dog(s) are a central focus when folks are home.
full time workers (9am - 5pm) as long as my dog has another friendly dog for company.
Other
106
When it comes to being WITHOUT PEOPLE during the day:* This field is required.Select all applicable
prefers company but can cope alone.
fine for half the day then becomes anxious.
needs someone home almost all the time.
ok for full time workers (9am-5pm) as long as my dog(s) are a central focus when home.
fine as long as they have each other (for bonded pairs).
Other
107
Do you require your dog to be the only permanent dog in the new home?* This field is required.
Yes
No - if ok after meeting the other dog (obviously this increases the risk of a placement failing during the 2 week cooling off period)
108
Describe the ideal home Optional
Consider space, company, exercise, families with kids, active seniors etc...
0/60
109
Anything else to help us understand your dog(s)' needs and personality Optional
Quirks, habits, routines, endearments, etc...
0/60
110
What do YOU LIKE about your dog(s)?
0/60
111
What do YOU DISLIKE about your dog(s)?
0/60
112
Why are you rehoming your dog(s)?* This field is required.
We don't judge - please be honest
0/60
113
By agreeing here you authorise DOG ADOPTION to publish the dog(s)' name and suburb as listed in this form and also to publish any photos and/or movies sent to DOG ADOPTION by you or any third party.* This field is required.
Agree
Disagree
114
I/we authorise DOG ADOPTION to publish the dog(s) profile at their discretion using the following:* This field is required.
websites - RECOMMENDED
social media - RECOMMENDED
emails / flyers - RECOMMENDED
newspapers, radio, TV (unlikely)
115
DOG ADOPTION aims to provide accurate information about potential new homes.

A higher level of disclosure is achieved by reassuring them we have asked you to do the same.

Robust T&Cs for BOTH parties are the key. Here are yours.
116
Date* This field is required.
Date
Day
Month
Year
117
Terms & Conditions* This field is required.Please check the box if you agree
118
I certify that I am the owner of the dog(s), free and clear of all other interests. I also certify the information I have provided about the behavioural and medical history of the dog(s) is true and complete to the best of my knowledge. Once I approve an adoptee, I irrevocably relinquish unto the approved adoptee all rights, title and interest in and to the dog(s) surrendered. I hereby forever release, discharge and agree to hold harmless and indemnify the DOG ADOPTION rehoming program, its members and agents from all claims, demands, actions, causes of action and liability of any kind whatsoever arising as a result of or in connection with the surrender and subsequent adoption or other disposition of this surrendered dog(s). I have read the above, I understand and agree to it.* This field is required.
Agree
Disagree
119
Signature* This field is required.Use your mouse
120
Total Payable
121
Calculation
122
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