Owner Surrender Form

I, certify the information provided on this form
to be true & correct. I understand that a physical evaluation of the dog, and a temperament test will be performed by an experienced rescue volunteer to ensure we feel the dog is re-homeable before my Dog is accepted into Rotten Rottie Rescue's program. If during the evaluation process they find the information contained in this surrender form to be false, I understand that they retain the right to turn down acceptance of the dog I am surrendering. I also understand this criteria must be met before Rotten Rottie Rescue will consider the acceptance of my Rottweiler. I understand if I am not able to meet these prerequisites, Rotten Rottie Rescue will take into consideration my circumstances which I have explained above in determining the acceptance of my Rottweiler.

If you are unable to pay the surrender fee
described, please explain why you are unable, provide proof if you are able, and let us know how much you can afford to pay, if anything. It will be easier for us to accept your dog with financial help to care for the dog. If you would like to donate more than then surrender fee described, please also state that.

I understand that once I leave my dog in Rotten rottie rescue’s care that I no longer have any rights to my dog. Should I want my dog returned to me, It will be at the sole discretion and Rotten rottie rescue, and what they feel is in the dogs best interest.

We reserve the right to refuse acceptance of
any rottweiler. Acceptance is based on many criteria, one of which is space availability. We are currently not excepting dogs from out of the state of Arizona unless special arrangements have already been made (rare)

Please email a minimum of four clear pictures of your dog to rottenrottierescue@gmail.com. Please be sure that the pictures are clear and well lit. Please take the pictures of your dog while he is awake and not sleeping. Best pictures are taken in the grass, in the day, with the dog’s mouth open, and his ears perked looking at the camera. Use a treat or toy to help you get good results. On the Internet, where we will be advertising, your dog’s pictures are everything. If your dog looks friendly and happy, more people will be interested in fostering or adopting him. Please note below if you have sent pictures previously so I know to look for them. Please also state where they were sent.

We must have proof of vaccinations, including rabies, a recent heartworm test, and proof of spay or neuter, and four clear pictures of your dog. If, and when your dog is excepted into Rotten Rottie Rescue and you cannot provide this proof, a $200 or more, depending on behavioral issues and age and health of the dog, donation will be required. If you provide this proof, and the dog has no major health or behavioral problems, the required fee will be $50 and is expected at the time that your dog is evaluated and accepted into our program. If your dog is pure bred, and under six months of age, the surrender fee will be waived. If you are having a hardship and cannot afford the surrender fee, please discuss it with us.

Dog's Name

Dog's Age and DOB if known

Sex

How much does your Dog weigh?

Please tell us why you are surrendering this dog, and please be specific.

What are you feeding your Dog, how much and how often, brand and formula?

Where is the dog located?

Do you own the dog and have him/her with you at this time?

How long have you had this Dog?

If this is not your Dog please explain in detail and give the name and phone number of the current owner.

Where did you originally purchase/find or adopt the dog?

If you purchased the dog from a breeder or if the dog was adopted from a rescue, did you sign a contract giving the breeder/rescue right-of-first refusal?

Please give the Breeder, Rescue or Shelter name/number where you purchased or adopted this Dog?

Have you contacted breeder/shelter/rescue? If no, why not? Please be specific.

Is the dog AKC Registered?

Do you have papers?

Is the dog an inside Dog or an outside Dog?

Veterinarians name and phone number. If you have never taken your dog to the vet, please state none.

Is the dog spayed or neutered? If yes, please provide proof of this in writing from your vet.

Is the dog micro chipped or tattooed, if so, what is the number?

When was the dog last tested for heartworm?

Did your dog test positive or negative?

Is the dog currently on heartworm preventative medication? When was the last dose given?

Is the dog current on his or her parvovirus, distemper, rabies, and bordatello vaccines? Please provide medical records with proof of such.

Please list any prior medical issues the dog has had in the past or currently has. Please state the timeframe the problem was present, and if it was fully resolved, or if follow treatment is still needed.

Please provide other details of known or suspected medical conditions of this dog, anything you provide us will only help us to help your dog sooner. Please know that we are aware of some dogs are given away because they have been diagnosed with a disease or a health problem, that does not in any way mean that we will not take them, please help us help your dog. By being completely candid with us.

Is the dog housebroken (potty trained) ?

How does the dog behave around adults?

Does the dog have difficulties with men?

Does the dog have difficulties with children? Has the dog lived with children? If not, please explain any experiences that the dog has had with children. Please state the ages of the children.

Does the dog have difficulties with women?

Has the dog ever snapped or bitten anyone? If so, please explain what happened and tell us how severe the bite was. If there are multiple incidences, please describe each incident.

Has the dog ever shown any aggression towards anyone or another animal? If yes, please explain and be specific.

Is the dog good and well socialized around male dogs, female dogs, small dogs, farm animals, cats?

If you answered yes to any of the animals above, please tell us about your dogs experiences with each. If you did not select an an animal, please also explain if your dog has aggression towards the animal or has just never been around one. Please be as specific as possible.

Does the dog need to be confined to his or her crate? Please explain.

Will the dog allow you or a stranger to examine his or her body without much trouble? If no, please explain.

Do you feel the dog is overly possessive about his food treats or toys? If yes, please explain in details below.

Please tell us about any other behavior issues this dog may have.

Did you take the dog to obedience training, if so, where?

Please list any commands the dog has knowledge of, and will do when I asked

When on a leash, do you walk the dog or does the dog walk you?

Has the dog been professionally guard or protection trained? Remote collar trained? Obedience trained?

Are you able to foster the dog until a foster home or adoptive home can be found? If not, please provide the last date the dog is able to stay with you.