Please provide a picture of the animal
Owners First Name *
Owners Last Name *
Address *
Postcode *
Home Telephone
Mobile Telephone
Email Address *
Are you the legal owner of the animal you are wish to rehome? *
No Yes
Animal's Name *
Species *
Bird
Cat
Chinchilla
Chipmunk
Degu
Dog
Ferret
Gerbil
Goldfish
Guinea Pig
Hamster
Mouse
Rabbit
Rat
Snake
Terrapin
Tortoise
Gender *
--
Male
Female
Colour *
Albino
Apricot
Black
Black and Brindle
Black and Brown
Black and Tan
Black and White
Blonde
Blue
Blue Merle
Blue Point
Brindle
Brindle and Black
Brindle and White
Brown
Brown and Black
Brown and White
Chocolate
Chocolate Point
Cinnamon
Cream
Dapple
Dark Eyed White
Fawn
Fawn and White
Fitch
Ginger
Ginger and White
Golden
Green
Grey
Grey and Tan
Grey and White
Grey Tabby
Harlequin
lemon and White
Lilac
Liver
Liver and White
Merle
Orange
Panda
Peach
Pineapple
Purple
Red
Red Merle
Ruby
Seal Point
Silver
Tabby
Tabby and White
Tan
Tan and Black
Tan and White
Torbi
Torti
Torti and White
Tricolour
Various
Wheaten
White
White and Black
White and Blue
White and Brindle
White and Brown
White and Cream
White and Grey
White and Liver
White and Tabby
White and Tan
White and Torti
White & Ginger
Yellow
Yellow and Grey
Yellow and White
Breed *
aa-Unknown
Abyssinian
Affenpinscher
Afghan Hound
African Grey
Airedale Terrier
Akita
Alaskan Malamute
Amazon Parrot
American
American Bulldog
American Eskimo Dog
American Staffordshire Terrier
American Water Spaniel
Angora Rabbit
Australian Kelpie
Australian Shepherd
Australian Terrier
Balinese
Basenji
Basset Hound
Beagle
Bearded Collie
Bedlington Terrier
Belgian Shepherd Dog Sheepdog
Belgian Shepherd Malinois
Bengal
Bernese Mountain Dog
Beveren
Bichon Frise
Birman
Bloodhound
Bobtail
Bombay
Border Collie
Border Terrier
Borzoi
Boston Terrier
Boxer
Briard
British Shorthair
Brittany Spaniel
Budgie/Budgerigar
Bulldog
Bullmastiff
Bull Terrier
Bunny Rabbit
Burmese
Cairn Terrier
Calico
Canary
Cane Corso Mastiff
Cavalier King Charles Spaniel
Chicken
Chihuahua
Chinchilla
Chinese Crested Dog
Chow Chow
Cinnamon
Clumber Spaniel
Cockatiel
Cockatoo
Cocker Spaniel
Collie
Conure
Conure
Corgi
Cornish Rex
Crossbreed
Dachshund
Dalmatian
Deerhound
Degu
Devon Rex
Doberman Pinscher
Dogue de Bordeaux
Domestic
Domestic Long Hair
Domestic Medium Hair
Domestic Rabbit
Domestic Short Hair
Dove
Dutch
Dutch Shepherd
Dwarf
Dwarf Eared
English Bulldog
English Bull Terrier
English Cocker Spaniel
English Lop
English Pointer
English Setter
English Shepherd
English Springer Spaniel
English Toy Spaniel
Exotic Shorthair
Extra-Toes Cat (Hemingway Polydactyl)
Ferret
Field Spaniel
Finch
Fish
Flat-coated Retriever
Foxhound
Fox Terrier
French Bulldog
French-Lop
Gecko
Gerbil
German Pinscher
German Shepherd Dog
German Shorthaired Pointer
German Wirehaired Pointer
Golden Retriever
Gordon Setter
Great Dane
Greater Swiss Mountain Dog
Great Pyrenees
Greyhound
Guinea fowl
Guinea Pig
Hamster
Harlequin
Havana
Havanese
Himalayan
Hound
Huntaway
Husky
Ibizan Hound
Iguana
Illyrian Sheepdog
Irish Terrier
Irish Water Spaniel
Irish Wolfhound
Italian Greyhound
Jack Russell Terrier
Japanese Chin
Japanese Chin
Kakariki
Labradoodle
Labrador Retriever
Lakeland Terrier
Lancashire Heeler
Lhasa Apso
Lilac
Lionhead
Lion Head
Lizard
Lop Eared
Lory/Lorikeet
Lovebird
Lurcher
Macaw
Maine Coon
Maltese
Manchester Terrier
Manx
Mastiff
Micro Bully
Miniature Pinscher
Mini-Lop
Mini Rex
Mountain Dog
Mouse
Mynah
Neapolitan Mastiff
Netherland Dwarf
Newfoundland Dog
New Zealand
Norfolk Terrier
Norwegian Forest Cat
Norwich Terrier
Old English Sheepdog
Old Tyme Bulldog
Otterhound
Palomino
Panda
Papillon
Parakeet (Other)
Parrot (Other)
Paterdale Terrier
Pekingese
Persian
Pharaoh Hound
Pocket Bully
Pointer
Pomeranian
Poodle
Pug
Quail
Ragdoll
Rat
Red Merle
Retriever
Rex
Rhea
Rhodesian Ridgeback
Rhodesian Ridgeback
Ringneck/Psittacula
Rosella
Rottweiler
Rough Collie
Saint Bernard St. Bernard
Saluki
Samoyed
Schnauzer
Scottish Deerhound
Scottish Terrier Scottie
Sealyham Terrier
Senegal Parrot
Setter
Shar Pei
Sheep Dog
Shetland Sheepdog Sheltie
Shiba Inu
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Skye Terrier
Smooth Fox Terrier
Spaniel
Sphynx (hairless cat)
Spitz
Staffordshire Bull Terrier
Sugar Glider
Terrier
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Toy Fox Terrier
Turkish Angora
Turkish Van
Weimaraner
Welsh Collie
Welsh Corgi
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier Westie
Whippet
Wirehaired Terrier
XL Bully
Yorkshire Terrier Yorkie
Age *
Is the animal microchipped? *
No Yes
Please provide the microchip number
Is the microchip registered to your name and address?
No Yes
If no, who is the microchip registered to?
Is the animal registered with a vet? *
No Yes
Please provide the name and address of the practice
Owner's reason for parting with animal
Has the animal lived with children?
--
Yes
No
Not known
If yes, please specify the ages of children and animal's behaviour with them
If no, has the animal had frequent contact with children? How Frequently?
Has the animal lived with animals other than cats and dogs? If so, please specify
Is the animal used to men and women?
Has the animal been neutered?
Yes
No
Unknown
Approximately when was it neutered?
Where did you get the animal from initially?
How would you describe your animal's behaviour? For example: bold, shy, timid, aggressive, affectionate
How does your animal react to grooming?
How does your animal behave at the vets?
Does your pet currently have any medical issues?
No Yes
Please provide full details including any medication that they are taking
Has your animal had any previous operations or treatment for medical conditions?
Does your animal have any known allergies?
Has he/she ever nipped or bitten?
Yes
No
If Yes, Please provide more details of circumstances?
Does the animal show any guarding (possessive) behaviour over food and or toys?
Has he/she any unusual behavioural habits?
Has your animal had their vaccinations in the last 12 months? *
No Yes
When was the animal last wormed and what with?
When was the animal last de-flead and what with?
Has the animal ever been destructive in the house? Please describe
Has the animal lived with dogs? If so, please specify age, sex and reaction
Has the animal lived with cats? If so, please specify age, sex and reaction
Please describe your animal's feeding regime - brands of food, scraps, dry or tinned, flavours, feeding times and quantities. Any dislikes?
Is the animal housetrained/litter-trained?
Does the animal travel well?
Do you leave the animal alone for any period of time? If so, how long for and do you have concerns about them being on their own?
Is the dog walked on a collar or a harness?
How does the dog react to other dogs outside of the home, e.g. on walks on and off the lead?
Will the dog give up toys when commanded to?
Does the cat use a scratching post, scratch at furniture, etc?
Is he/she used to a gravity water feeder, e.g. bottle or bowl?
Is he/she used to being handled?
Please describe the animals current accommodation.
We do normally ask for a donation towards our costs of looking after the animal. Are you prepared to make such a donation? *
No Yes
Donation Amount
---
Suggested Minimum £15 (SMALL ANIMAL)
Suggested Minimum £25 (CAT)
Suggested Minimum £50 (DOG)
£75
£100
Other Amount (Please Specify)
Please specify amount £
Person providing information
--
Owner
Inspector
Owner's representative
Name