Animal Surrender form

As the cost of living increases in this current climate we appreciate that the cost of keeping a dog has increased massively. This, however is also the case for ourselves and as a result we would kindly ask for a minimum donation of £50 when surrendering a dog into our care that we can put towards the feeding, cost of the vaccinations, neutering, feeding and any other requirements the dog may have. Answering these questions honestly will not stop Benvardin Kennels from admitting your animal but will simply ensure that we are able to provide the correct care for your pet.

Photo Please include a recent photo of your dog for our records
Animal Name *
Microchip number Please insert your pet's microchip number.
Breed *	Affenpinscher Afghan Hound Airedale Terrier Akbash Akita Alaskan Malamute American Bulldog American Eskimo Dog American Staffordshire Terrier American Water Spaniel Anatolian Shepherd Appenzell Mountain Dog Australian Cattle Dog/Blue Heeler Australian Kelpie Australian Shepherd Australian Terrier Basenji Basset Fauve de Bretangne Basset Hound Beagle Beagle Harrier Bearded Collie Beauceron Bedlington Terrier Belgian Shepherd Groenendael Belgian Shepherd Laekenois Belgian Shepherd Malinois Belgian Shepherd Tervuren Bernese Mountain Dog Bichon Frise Black and Tan Coonhound Black Labrador Retriever Black Mouth Cur Bloodhound Blue Meryl Bluetick Coonhound Border Collie Border Terrier Bordoodle Borzoi Boston Terrier Bouvier des Flanders Boxer Boykin Spaniel Briard British Bulldog Brittany Spaniel Brussels Griffon Bull Lurcher Bullmastiff Bull Terrier Cairn Terrier Canaan Dog Cane Corso Mastiff Carolina Dog Catahoula Leopard Dog Cattle Dog Caucasian Shepherd Cavajack Cavalier King Charles Spaniel Chesapeake Bay Retriever Chihuahua Chinese Crested Dog Chinese Foo Dog Chocolate Labrador Retriever Chow Chow Clumber Spaniel Cockapoo Cocker Spaniel Collie Coonhound Corgi Coton de Tulear Dachshund Dalmatian Dandi Dinmont Terrier Doberman Pinscher Dogo Argentino Dogue de Bordeaux Dutch Shepherd English Bulldog English Bull Terrier English Cocker Spaniel English Coonhound English Pointer English Setter English Shepherd English Springer Spaniel English Toy Spaniel Entlebucher Eskimo Dog Field Spaniel Fila Brasileiro Finnish Lapphund Finnish Spitz Flat-coated Retriever Foxhound Fox Terrier French Bulldog German Pinscher German Shepherd Dog German Shorthaired Pointer German Wirehaired Pointer Glen of Imaal Terrier Golden Doodle Golden Retriever Gordon Setter Great Dane Greater Swiss Mountain Dog Great Pyrenees Greyhound Harrier Hound Havanese Hound Hovawart Husky Ibizan Hound Illyrian Sheepdog Irish Setter Irish Shepherd Irish Terrier Irish Water Spaniel Irish Wolfhound Italian Greyhound Italian Spinone Jackahuahua Jack Russell Terrier Japanese Chin Jindo Kai Dog Karelian Bear Dog Keeshond Kerry Blue Terrier King Charles Kishu Komondor Kuvasz Kyi Leo Labradoodle Labrador Labrador Retriever Lakeland Terrier Lancashire Heeler Leonberger Lhasa Apso Lowchen Lurcher Lurcher Maltese Manchester Terrier Maremma Sheepdog Mastiff McNab Miniature Jack Russell Terrier Miniature Pinscher Miniature Schnauzer Miniature Yorkshire Terrier Mixed Breed Mountain Cur Mountain Dog Munsterlander Neapolitan Mastiff Newfoundland Dog New Guinea Singing Dog Norfolk Terrier Norwegian Buhund Norwegian Elkhound Norwegian Lundehund Norwich Terrier Nova Scotia Duck-Tolling Retriever Old English Sheepdog Other Otterhound Papillon Parsons Terrier Patterdale Terrier (Fell Terrier) Patterjack Pekingese Peruvian Inca Orchid Petit Basset Griffon Vendeen Pharaoh Hound Pit Bull Terrier Plott Hound Pocket Bully Pocket Bully Pointer Polish Lowland Sheepdog Pomeranian Poodle Portugese Podengo Portuguese Water Dog Presa Canario Pug Puggle Puli Pumi Rat Terrier Redbone Coonhound Retriever Rhodesian Ridgeback Rottweiler Rough Collie Saint Bernard St. Bernard Saluki Samoyed Schipperke Schnauzer Scottish Collie Scottish Deerhound Scottish Terrier Scottie Sealyham Terrier Setter Shar Pei Sheep Dog Shepherd Shetland Sheepdog Sheltie Shiba Inu Shih Tzu Siberian Husky Silky Terrier Skye Terrier Sloughi Smooth Fox Terrier South Russian Ovcharka Spaniel Spitz Springador Sprocker Sprollie Staffordshire Bull Terrier Staffy Jack Swedish Vallhund Swiss Shepherd Terrier Thai Ridgeback Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Tosa Inu Toy Fox Terrier Treeing Walker Coonhound Vizsla Weimaraner Welsh Corgi Welsh Springer Spaniel Welsh Terrier West Highland White Terrier Westie Wheaten Terrier Whippet White German Shepherd Wire-haired Pointing Griffon Wirehaired Terrier XL Bully Xoloitzcuintle/Mexican Hairless Yellow Labrador Retriever Yorkshire Terrier (Yorkie)
Sex *	Male Female
Age *
Brief Description Please describe your dog briefly
Has the animal lived with children?	NoYes
If so, please specify ages	Any age 5 years and under 5 to 12 years
If no, has the animal met children and what was his/her reaction?
What age groups were any children met?
Has the animal lived with dogs?	NoYes
If so, please specify age and sex
Has the animal lived with cats?	NoYes
If so, please specify age and sex
Has the animal lived with animals other than cats and dogs?	NoYes
If so, please specify the species	Cat Dog
Is the animal used to men and women?
Has the dog ever bitten? *	NoYes
If Yes, please give details
What is the animal's reaction if you approach it when it is feeding?
Please describe your animal's feeding regime - brands of food, scraps, dry or tinned, flavours, feeding times and quantities. Any dislikes?
Has the animal been neutered?	Not known Yes No
What commands does your animal obey? And what commands are used? For example, sit or sit down; lie or lie down etc.
Owner's reason for parting with animal
Where did you get the animal from initially?
Is the animal upto date with its annual vaccinations?	NoYes
Date of last vaccination
Is the animal housetrained?	NoYes
Does the animal travel well in cars?	NoYes
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?
Has the animal ever been destructive in the house? Please describe
Where does the animal sleep?
Will the animal give up toys when commanded to?	NoYes
Would you describe your animal as a gentle player or does he/she like "rough" play? Describe your animal's play activity, eg. favourite game, favourite toy, etc.
How does your animal react to grooming?
hHow does your animal behave at the vets?
How does your animal react when he/she has done something wrong? How do you "tell him off"?
Does the animal pull on the lead?	NoYes
Does your animal return when called whilst off the lead?	NoYes
First name *
Surname *
Address *
Town *
Postcode *
Telephonenumber *
Emailaddress
Additional comments
Person providing information	Owner Agent Inspector Family Member
Signed by * By signing this form I declare that the information provided is true.	Clear