Dog surrender form - RSPCA South Australia

Your details

Name*

Title First name Last name

Phone number*

Email address*

Current address*

Street Suburb Postcode

Which RSPCA South Australia shelter is closest to you?*

Your dog's details

If you wish to surrender more than one animal, please fill out one form per animal.

Dog's name*

Age*

Breed*

Gender*

Is your dog desexed?*

Is your dog microchipped?*

If yes, what is the microchip number?

Is your dog registered with a council?*

If yes, which council?

Where did you get your dog from?*

How old was your dog when you acquired him/her?*

Are you surrendering your dog because you can't afford vet treatment?*

If no, why are you surrendering your dog?

If yes, can you explain what the vet issues are?

Lifestyle and home life

Is your dog allowed inside?*

Is your dog allowed outside?*

Where does your dog prefer to spend most of its time?*

Has your dog ever escaped or tried to escape?*

If yes, how long ago did the escaping attempts start?

The moment escaping starts can often relate to a time of change in your dog's life, which is important information for our behaviourists.

If yes, how did your dog escape or try to escape?

Please select all that apply.

Jumped fence
Climbed fence
Dug under fence
Other

If yes, how often has your dog escaped or tried to escape?

Please select all that apply.

Several times a week
Once a week
Several times a month
Other

How high are your fences and what are they made of?

Please select all that apply.

4 feet
6 feet
Higher than 6 feet
Chain mesh or wire
Colourbond
Brick

Where is your dog kept when no one is home?*

What does your dog do as you leave the house?*

What does your dog do when left home alone?*

What does your dog do when you return home?*

Where does your dog sleep at night?*

How much time does your dog spend on his/her own?*

Does your dog follow you from room to room when you are home?*

Do you have any other dogs?*

Do you have any cats?*

Do you have any other pets?*

If yes, what other pets do you have?

How does your dog interact with these other pets?

Which pet arrived in your house first?

Social interactions

How would you describe your household?*

How many adults live in your household?*

Please enter a number from 0 to 15.

Do children live in your household?*

If yes, what are the children's ages?

Do any of the children play with dog?

If yes, does the dog:

Does the dog need to be taught to be gentler when he/she plays with children?

How often does the dog require 'time out' from the children?

Has your dog met:

Select all that apply.

Many children?
Many adults?
Many other dogs?
Many other animals?

Please describe any unpleasant situations involving children, adults, or other animals

How does your dog react when people or strangers come to the house?*

How long does it take him/her to calm down?*

Does your dog have access to visitors?*

Do you need to restrain him/her, or is he/she free to interact?*

Is your dog happy to be touched and handled by visitors and strangers?*

If no, how does your dog react?

Are there any parts of his/her body that your dog doesn’t like being touched by visitors/strangers (eg: paws, head)?*

When INSIDE the home, how does your dog react to unfamiliar men?*

When OUTSIDE the home, how does your dog react to unfamiliar men?*

When INSIDE the home, how does your dog react to unfamiliar women?*

When OUTSIDE the home, how does your dog react to unfamiliar women?*

When INSIDE the home, how does your dog react to younger children?*

When OUTSIDE the home, how does your dog react to younger children?*

When INSIDE the home, how does your dog react to older children?*

When OUTSIDE the home, how does your dog react to older children?*

When INSIDE the home, how does your dog react to other dogs?*

When OUTSIDE the home, how does your dog react to other dogs?*

When INSIDE the home, how does your dog react to cats?

When OUTSIDE the home, how does your dog react to cats?

Behaviour and temperament

How active is your dog?*

How playful is your dog?*

How affectionate is your dog?*

Does your dog like to hunt or chase prey?*

Does your dog like to be patted and touched?*

Is your dog outgoing and interactive or shy and likes to be left alone?*

Does your dog enjoy being picked up and handled?*

Has your dog ever scratched anyone (even if while playing or scared)?*

If yes, please give us more details:

Has your dog ever bitten anyone (even while playing)?*

If yes, what happened?

Has your dog ever been in a fight with another dog?*

If yes, what was the fight over? How old was your dog at the time?

Has your dog ever needed to be muzzled for any reason?*

If yes, under what circumstances?

Does your dog travel well?*

Does your dog vocalise excessively?*

If yes, when and why? Have the neighbours ever complained?

Is there anything that may cause your dog to be nervous or fearful?*

If yes, what specifically?

Storms
Fireworks
Loud noises
Camera flashes
Other dogs
Other animals

How does your dog react?

Food and feeding

What do you feed your dog?*

How many times a day is your dog fed?*

At what time of day is your dog fed?*

Is your dog comfortable with people being around when he/she is fed?*

If no, what does the dog do in this situation?

Is your dog comfortable with other animals being around when he/she is fed?*

If no, what does the dog do in this situation?

Can you easily take food, bones or toys from your dog?*

If no, what is your dog's reaction when you try to take such items?

Training

Has your dog attended training or puppy classes?*

If yes, what classes? How long ago? Where? What methods were used? (For example, treat training, check chain.)

What cues and commands does your dog respond to?

Sit
Stay

Does your dog come when called?*

How well does your dog walk when on a leash?*

Do you use any walking equipment?*

Does your dog enjoy being picked up and handled?*

Health and vaccinations

Has your dog ever had any vaccinations?*

If yes, approximately when was the last vaccination?

Can you provide a vaccination certificate to RSPCA?

Please upload a copy of your dog's most recent vaccination certificate.

This document is crucial in helping us determine whether or not your dog might need quarantining.

Drop files here or

What is the name of your current vet?

First name Last name

What are the contact details for your current vet?

How does your dog behave at the vet?

When was the last time you took your dog to the vet?*

Does your dog have any medical conditions/history that you are aware of?*

Please include visits to the vet for dog fights, illnesses and accidents.

If yes, please provide full details:

Is your dog currently on any medication, including heartworm preventative?*

If yes, please provide full details:

Exercise and play

How often is your dog walked?*

How long does each walk generally last?*

Where do you take your dog when you walk him/her?*

Describe your dog's reaction when he/she sees another dog:*

Do you regularly exercise your dog off-leash?*

Do you let your dog sniff and play with other dogs (outside the home)?*

Does your dog have a best friend or doggy playmate?*

If yes, please provide details of the playmate (lives in same household? breed, sex, age etc.):

What are your dog’s favourite games to play?

What are your dog’s favourite kinds of toys?

Is your dog rough and/or mouthy during play?*

If yes, please describe:

Grooming

How often do you bath your dog?*

How often do you brush your dog?*

How does your dog behave when groomed?

Has your dog ever been professionally groomed?*

Can you easily trim your dog's claws?*

Final details

List three words that would describe your dog?

For example: loner, affectionate, demanding, playful, food motivated, etc.

List three things that make your dog happy:

What sort of home and family do you believe would suit your dog?*

Are there any quirks or habits that you are not fond of in your dog?

Is there anything else you would like to tell us about your dog?