Surrender Application

Upon receipt of the completed form, we will assess whether we have any available homes or capacity to assist you. Please understand that completing the surrender form does not guarantee that we will be able to accommodate or accept the dog.

If your dog is accepted by SABBR, a $100 fee is applicable per dog which is to be paid prior to intake.

Unless specified, all fields marked with an asterisk (*) are mandatory.

Dog information
Dog's Name *
Breed *
Colour/Markings *
Age *
Date of Birth (if known)
Sex *
Approximate weight of dog (kg) *
Health & medical history
Sterilised *
Sterilisation Date
Vaccinated *
Date of Next Vaccination
Heartworm Treatment Given *
Date of Next Heartworm
Worming Treatment Given *
Date of Next Worming
Flea Treatment Given *
Date of Next Flea Treatment
Microchipped *
Microchip Number
Registered *
Local Shire / Council Registered To
Registration Expiry
Does your dog have any known health issues, medical needs, past or present injuries *
Please give details of injuries or medical conditions *
Please provide details of any treatment plans, medications or therapy undertaken
What is the name of your regular vet? *
Behaviour
Does your dog know any of these commands *
Approximately how long is your dog left alone for on a regular day? *
Has the dog lived with children previously *
What are the children ages
Has the dog shown any signs of aggression, reaction or fear towards children *
What age group has the dog been aggressive to *
Please provide further details on interactions with children *
Has the dog shown any signs of aggression, reaction or fear towards adults *
Please provide further details on the circumstances, frequency and how long ago it occurred *
Does your dog get along with other dogs? *
Please provide details of interactions with other dogs: *
What animals has your dog lived with and / or gets along with *
What animals are you aware that the dog does not get along with *
Has your dog shown aggression, reaction or fear to any of the following *
If others, please give details
Have you ever sought professional help for any behaviours *
If yes, please provide name of organisation and what advice they provided
Please explain in detail the reason for wanting to surrender your dog *
Photo One *
Photo Two *
Other information
Did you adopt your dog from a rescue? *
If yes, please provide the name of the rescue. *
Is there any other information that you think may be important?
Owner's Details
Are you the legal owner of this animal? *
If you are not the legal owner, please provide more details: *
First Name *
Surname *
Street Address *
Suburb *
State *
Postcode *
Mobile Phone *
Home Phone
Best time to contact you? *
Email *
Confirm email
I understand that completing this application does not guarantee intake by Staffy and Bully Breed Rescue Inc. *
I have completed the information in this document to the best of my knowledge and am aware that the information contained within will be used to find an appropriate home for the dog named on the application and that any false or misleading information may hinder this process. *
Signature *

Staffy and Bully Breed Rescue Inc. | Charitable Collections Licence CC21699

Surrender Application

Dog information

Health & medical history

Behaviour

Other information

Owner's Details