Animal Name *

Species *

Breed *

Sex *

Upload copy of desexing certificate

Date of birth

Or Estimated Age

Microchip Number

Is your animal -? *

Deaf
Blind
Deaf and Blind
with Special Needs

Has the animal lived with children?

If yes, please specify ages

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?

If so, please specify age and sex

Has the animal lived with cats?

If so, please specify age and sex

If the animal lived with cats, what kind of interactions did they have? e.g. did they play, chase, or were they separated?

Has the animal lived with animals other than cats and dogs?

If so, please specify the species

Is the animal used to men and women?

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 your animal ever injured another animal or human?

If yes, please provide details of the incident(s).

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 up to date with its annual vaccinations? *

Date of last vaccination

Upload copy of vaccination certificate

Is your animal currently on any medication, if so which and what dosage?

Does your animal show any of the following behaviours? Spinning in circles, Chasing own tail, Running fence lines, Shadow chasing, Pouncing, Fly snapping.

Does your dog bark a lot? What type of situations may trigger the behaviour?

Is the animal housetrained?

Does the animal travel well in cars?

Does your dog have escaping issues, what have you done to remedy?

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?

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?

How 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?

Does your animal return when signalled whilst off the lead?

How would you describe your animal to someone?

Surrender Information

First name *

Surname *

Address *

Postcode *

Telephone Number *

Email Address *

Person providing the information *

Image of your animal

Image of your animal 2

Declaration

I hereby give Hear No Evil - Australian Deaf Dog Rescue permission to request all medical history and medical records from my Veterinarian for the animal I am requesting assistance for.
I hereby confirm that I am the legal owner of this animal, and all information provided is true and correct to the best of my knowledge.
I hereby confirm that this animal has not been declared dangerous and there are no outstanding fines, complaints or local council orders with regard to this animal.
I understand and agree that by signing this form I am authorising Hear No Evil - Australian Deaf Dog Rescue to assist in a private rehoming of my pet. I understand that Hear No Evil are under no obligation whatsoever to take my pet into their care.

Please sign here *

Hear No Evil - Surrender/Rehoming Form

Surrender Information

Declaration