9. Surrender Form 2026

It is essential that all questions are completed fully, honestly and with as much detail as possible. These questions form an important part of both our statutory records and our internal processes, and provide the information we rely on to assess each dog appropriately.

Providing accurate and detailed information enables us to better understand each dog’s needs, ensuring we can place them as safely and suitably as possible within a foster home, rehabilitation setting or permanent placement. It also helps future carers and adopters support the dog more effectively by understanding their history, behaviour and established routines.

We cannot emphasise strongly enough the importance of disclosing any behavioural issues. Failure to provide full and accurate information can place foster carers, children, members of the public and other animals at risk of injury. Honest information allows us to put appropriate safeguards and support in place from the outset.

In relation to confidentiality, please note that as UKBTR no longer accepts generic adoption applications, it may be necessary to advertise dogs on social media and/or our website in order to secure the most suitable home. While every effort will be made to respect privacy and handle information sensitively, anonymity cannot be guaranteed. If you would prefer your dog to be advertised under a different name, please inform us at the point of surrender.

The dog

Dog's name
Do you want your dog referred to by a different name when advertised for adoption? If yes, which name?
Do you want your dog referred to by a different name when advertised for adoption? – details
DOB / age
Reason for surrender
Breed
Colour
Sex
Neutered If no, date of last season if a bitch.
Neutered – details
Date last wormed
Date last flea treated
Date last vaccinated
Vaccination card present? Please note, we do require proof of vaccinations so we know what the dog needs & when.
Does the dog have any history of illness/operations? History If so, what and when?
Does the dog have any history of illness/operations? – details
What age was this dog when you got him/her?
Where did you get him/her from?
If Rescue or Pound, which one?
Does the dog legally belong to you?
Approximately how many owners has he/she had?
Do you know much about his/her past? Please explain.
Used to children? Behaviour If yes, what ages?
Used to children? – details
Used to cats?
Other furries?
Aggressive towards other dogs?
If yes, is he/she aggressive to male / female / both dogs?
In what circumstances / triggers?
How have you dealt with this?
Has your dog ever attacked another dog and caused injury requiring veterinary treatment? If so, please give details.
Has your dog ever attacked another dog and caused injury requiring veterinary treatment? – details
Aggressive towards humans?
If yes, in what circumstances / triggers?
Has your dog bitten?
If yes, in what circumstances / triggers?
How many times approximately?
Who has your dog bitten? (i.e. family members/friends/strangers)
Has your dog broken skin?
If yes, did the person who sustained the bite require hospital treatment? If yes, please detail.
How have you dealt with this?
Has your dog shown aggression/possessiveness over items such as toys, furniture or food? Please give details.
Has your dog shown aggression/possessiveness over items such as toys, furniture or food? – details
If yes, how have you dealt with this?
Have you ever sought the advice of a dog trainer/behaviourist? If yes, please detail advice/opinion given. Please include any behavioural reports and/or details of the behaviourist if you have them.
Have you ever sought the advice of a dog trainer/behaviourist? – details
How often and for how long is your dog exercised daily? Exercise Be as honest as possible – no one is criticising you. It is essential so we know how much exercise to give your dog initially.
Is your dog let off lead?
Recall?
Is your dog used to being left? If so, for how long?
Is your dog used to being left? – details
Where is he/she kept when left?
Does he/she exhibit any destructive tendencies/separation anxiety? If so, please give details.
Does he/she exhibit any destructive tendencies/separation anxiety? – details
Does he/she travel well in a car? Travel Is he/she used to being crated or harnessed in the car?
Does he/she travel well in a car? – details
What food do you use? Feeding
How much do you give at each mealtime?
What times of day is your dog currently fed?
Where does your dog currently sleep? Sleeping arrangements
Does he/she have his/her own bed?
Will you provide his/her bed?
Is he/she crate trained?
Is he/she housetrained? Please include details if not/not reliable.
Is he/she housetrained? – details
What commands does your dog know? Which words do you use to encourage him/her to go to the toilet?
Any other information you feel would be useful
Vet’s name, address and telephone no I have read and understand that this is a legally binding agreement between myself as current owner of the aforementioned dog and UK Boston Terrier Rescue and I hereby transfer ownership of the dog to UK Boston Terrier Rescue. Vet I give permission to the above mentioned vets to pass on veterinary records for my dog if requested.
Microchip number & company Microchip – essential
If tattooed: tattoo number & company
In whose name/s is the dog microchipped?
Who is the registered owner? Ownership – essential
Pedigree paperwork; in whose name?
In whose name/s is the dog registered at the vet?
Signed (ORIGINAL OWNER) IMPORTANT: Before surrendering your dog to rescue/rehab, we would ask you to think long and hard about your reasons and to be absolutely certain that this is the step you wish to take. If you have surrendered your dog due to human aggression, we will have him/her independently assessed by a fully qualified behaviourist and vet. In some circumstances, it may be the opinion of the vet and the behaviourist that the dog is not considered safe to be rehomed. Should that be the case, then UKBTR will, on advice, consider euthanasia. This is ALWAYS an absolute last resort. UKBTR request that dogs are neutered and must be up to date with vaccinations, flea and worm treatment prior to coming into rescue. If you would like to make a donation to reimburse UKBTR a portion of the ongoing expenses of rescue and rehabilitation, this would be most welcome; see details below. PAYPAL: donation@ukbostonterrierrescue.co.uk BANK: HSBC, UK Boston Terrier Rescue ACCOUNT NUMBER: 52094045 SORT CODE: 40-09-18 PLEASE QUOTE YOUR DOG’S NAME AS THE REFERENCE AND ADVISE WHICH PAYMENT METHOD YOU USE. Owner signature
Date
Name (BLOCK CAPITALS)
Address
Email
Telephone no/s
Donation amount

This form MUST be completed, signed and returned with a CLEAR PHOTOGRAPH of your dog and any other documents prior to the handing over of the dog. PLEASE GIVE THE VACCINATION CARD TO THE TRANSPORTER.

Please send to:

UKBTR
PO Box 5614
Glasgow
G52 9DN

In the meantime, to allow us to begin the process, please email this form to: info@ukbostonterrierrescue.co.uk

Privacy information

This privacy information sets out how UK Boston Terrier Rescue (UKBTR) uses and protects any personal information that you provide us.

UKBTR is committed to ensuring that your privacy is protected. Should we ask you to provide certain information by which you can be identified when using our rescue services, you can be assured that it will only be used in accordance with this privacy statement.

Why we collect your data

We collect your personal data in order to enable the objectives of the rescue to be achieved:

To rescue, rehabilitate and rehome Boston Terriers, Boston Terrier crosses and other small brachycephalic breeds
To raise awareness with the public on the proper care of Boston Terriers and the treatment of various health issues they can suffer from
To provide support, help and advice to Boston Terrier owners
To claim relevant tax relief from donations (i.e. Gift Aid)
To ensure compliance with the Charities Commission

What we collect

We may collect the following information in relation to:

Dogs' previous owners
Adoption applicants and Adopters
Foster applicants and Fosterers
Homecheck applicants and Homecheckers
Transporter applicants and Transporters
Veterinary records
Further information in relation to reports from other Dog Health Professionals, such as Behaviourists and Physiotherapists

What we do with the information we gather

We require this information for the purpose of:

Professional record keeping of owner, dog and volunteer information
Ensuring the successful matching of a dog to a new home
Sharing information with volunteers involved in the rescue

Security

We are committed to ensuring that your information is secure. In order to prevent unauthorised access or disclosure, we have put in place highly secure electronic systems and managerial procedures to safeguard and secure the information we collect.

Controlling your personal information

We will not distribute, sell or lease your personal information to third parties unless we have your explicit permission or are required by law to do so.

You may request details of personal information which we hold about you under the General Data Protection Regulation (GDPR). If you would like a copy of the information held on you please contact Beth Bartlett, Data Protection Officer, at this email address: info@ukbostonterrierrescue.co.uk.

If you believe that any information we are holding on you is incorrect or incomplete, please email as soon as possible at the above address. We will promptly correct any information found to be incorrect.

How you can withdraw and request to be deleted from our files

If you do not wish us to make use of your Personal Information in this way, please contact Beth Bartlett at this email address: info@ukbostonterrierrescue.co.uk. You have the right to withdraw consent.

Should you have any queries in relation to General Data Protection Regulation (GDPR), please do not hesitate to contact us, using the contact details above.