Surrender Request Form- Ellie's Canine Rescue & Rehome

First Name *
Last Name *
Mobile Phone Number *
Home Address *
Email Address *
Name of Dog / Pup *
Age of dog / pup *
Breed of Dog *
Size (approx) *	XS- 0-4kg S- 5-10kg M- 11-19kg L- 20-29kg XL-30-45kg Giant - 45kg plus
Gender *	Male Female
Colour *
Why are you rehoming your dog
Does your dog have any of the following: *	Up to date with flea & worm treatment Current vaccinations microchip Current council registration Desexed
Is your dog classified as Menacing or Dangerous by the Council? *	NoYes
Socialisation *	Really friendly, no situation upsets them Can be shy in new situations otherwise great Anxious when left alone Leash Reactive Scared of some people Fear aggressive
Has your dog ever bitten a person or another dog? If yes please explain the circumstances *
Is the dog safe with cats and other common household pets? *	NoYes
Does this dog currently live with children? If so what are their ages? *
What is their training like? e.g. What are they like on the lead? Do they know basic commands? *
Does your dog jump fences? *	Has never jumped any fence ever Only if its under 90cm Only if its under 1.2m Only if its under 1.5m Only if its under 1.8m Only if its under 2m No fence can contain this dog
Are there any other comments your would like to make? *
Will you be making a donation or koha to us? *
I will email photos of the dog to elliesk9rescue@gmail.com *	NoYes
I confirm I am the lawful and legal owner of this dog *	NoYes