RBBOP - Additional dog information

This form contains the details of additional dogs that form part of the application submitted by the person listed below.
Applicant details
First Name *
Surname *
Suburb *
Postcode *
Mobile phone *
Email *
Confirm email
Are you the legal owner of the dog? *
Who is the legal owner and do you have permission to apply?
Dog details (staffy & bull breeds only)
Dog's name *
Dog breed/type *
Please describe the dog
Please upload a photo of the dog. *
Dog sex *
Dog colour *
Dog age *
Is your dog microchipped? *
Microchip number
Is the dog registered? *
Where did you get your dog? *
Where if not defined?
Dog's living situation
Reproductive status
If your dog is female
Has she ever had a litter? *
If yes: when, approx. how many puppies, and what happened to them? *
Has she been in season (on heat) in the past 6 months? *
Other pets in the household Please include quantity, species and sex e.g. 2 cats, M, F
If yes: approximate date of her last season *
Could she be pregnant right now? *
If yes/unsure: provide details (dates, exposure to entire male, any signs). *
How do you prevent mating when she is in season? *
If a vet confirms pregnancy, which option best matches what you would consider (after veterinary advice)? *
If your dog is male
Has he ever sired a litter (known or suspected)? *
If yes/unsure: provide details (dates, exposure to entire female, escapes). *
How do you prevent him mating with female dogs in season? *
Have you noticed any of the following? *
If other, please describe behaviour: *
Veterinary history & health
Has your dog ever visited a veterinary clinic? *
If yes, which veterinary clinic? *
Approximate date last seen by a vet *
Vaccination status *
Flea/worming status *
Any current health concerns? *
Please describe: *
Signature *

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

RBBOP - Additional dog information

Applicant details

Dog details (staffy & bull breeds only)

Reproductive status

If your dog is female

If your dog is male

Veterinary history & health