VBTR Surrender Contract

Title *
First Name *
Last Name *
Your email address *
Confirm email
Mobile No * * numbers only, no spaces or symbols
Home No * numbers only, no spaces or symbols
Street Address *
Town/Suburb *
State *
Postcode * * numbers only, no spaces or symbols
Country *
Council/Municipality eg. Maroondah Council
Driver License Please upload a copy of your current Driver Licence or Passport for security purposes. Thank you.
It is accepted that the above named person surrenders to Victorian Bull Terrier Rescue Inc. a canine described as follows:
Name of Dog
Date of Birth
Approx. Age if D.O.B. not known * numbers only, no spaces or symbols
Sex of Dog *	Male Female
Desexed	Yes No
Please upload proof of sterilisation
Colour/Markings
Weight (kgs) * numbers only, no spaces, symbols, letters or words
Worming Due
When was your dogs last vaccination?
Please upload most recent vaccination certificate
Microchip No. * * numbers only, no spaces or symbols
Heartworm Treatment Due
Are you the registered owner on your dogs microchip * Please select correct box	Yes No Microchip in breeders name
If you selected NO to being the registered owner on your dogs microchip above please provide explanation *
Please upload a copy of the microchip certificate in your name * Failing to provide a valid microchip certificate matching to your name will delay the process.
Please advise the name and contact number of your dogs current veterinary hospital
Registered	Yes No
Bred By
Pedigree Papers	Yes No
Please upload your dogs pedigree papers
Have you contacted the breeder prior to completing this form?	Yes No
Please upload a photo of your bull terrier
Under the following Terms & Conditions:
I hereby certify that I, * Please type your full name
am the rightful owner/keeper/caretaker/custodian of the animal(s) who is/are the subject of this Surrender Contract, hereinafter referred to as “the Bull Terrier”. I hereby surrender any and all property rights to the Bull Terrier. I certify that no other person has a right of property to the Bull Terrier. I understand that by surrendering my property rights to the Bull Terrier, the Bull Terrier may be transferred into the custody of Victorian Bull Terrier Rescue Inc. I also hereby certify that the Bull Terrier has not bitten or scratched a human or another animal within the past 10 days. I understand that once I relinquish the Bull Terrier, the Bull Terrier will not be available to be returned. I further certify that I have read and understand the terms of this Surrender Contract.
Please date: *
Are you able to foster your Bull Terrier until Victorian Bull Terrier Rescue Inc. find a suitable home? *	Yes No
The following questions are to assist our foster carers & to make the transition into a new environment as easy as possible for your dog. The more we understand about your dog, the easier it will be for us to place him/her.
1. Please tell us a little about your Bull Terrier, how long you have owned your dog & why you are rehoming him/her?
2. Does your dog get along with other animals. If so, which animals? If not, please describe how they react when meeting another animal.
3. Is your dog dominant or submissive with other dogs? Does your dog prefer other male or female dogs?
4. Is your dog prey driven?Do they want to chase cats or small dogs? Has your dog ever injured or killed another animal?
5. How does your dog react when meeting new people, are they friendly, relaxed, boisterous, anxious, aggressive?
6. Does your dog have a particular preference for men or women & how do they behave around children?
7. Does your dog growl or bark when you have visitors? Are they protective of you, your vehicle or your property?
8. Has your dog had any obedience training, can they sit, stay, drop, wait for meals etc.?
9. Does your dog walk well on the lead or does he/she pull? When off the lead, does your dog have good recall?
10. Does your dog travel well in the car?
11. Is your dog used to going to public places, if so, how does he/she behave?
12. Does your dog show any signs of food aggression? Are you able to remove a food bowl or a bone from your dog?
13. Is your dog possessive over food or toys? Will your dog allow another dog near his/her food or toys?
14. If your dog lives with another animal, what is their routine at feed times?
15. What do you feed your dog & how often?
16. Does your dog have any special dietary requirements?
17. Does your dog have any health issues or medical requirements?
18. Does your dog live inside or outside, where are they used to sleeping?
19. Is your dog housetrained?
20. Is your dog crate trained? Has your dog ever been kennelled?
21. How many hours a day is your dog used to being alone? Where is your dog kept when you are out?
22. Does your dog have separation anxiety? If so, what form does this take? Does your dog bark, or become destructive when left alone?
Any other comments
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Victorian Bull Terrier Rescue Inc. Representative