Owner Surrender Form

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?

Veterinarian's name and phone #:

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 heartworms?

Did your Dog test positive or negative?

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

Is this dog current with his/her parvo, distemper, rabies and bordatello vaccinations?

Please list any prior medical issues the dog has had in the past or currently has. Please state the time frame the problem was present, and if it was fully resolved or if follow up 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 we are aware some Dogs are given away because they have been diagnosed with a disease or health problem, that does not in any way mean we will not take them, please help us to help your Dog, by being completely candid with us.

Is the dog housebroken?

How does the dog behave around adults?

Difficulty with Men?

Difficulty with Women?

Difficulty with children? Is the dog good around children? Has the dog lived with children? If so, what age are the children?

Has the dog ever snapped or bitten anyone?

If yes, did it break skin?

was it reported?

please explain what happened

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

If you did not select any of the choices above, please explain & be specific.

Does this Dog need to be confined to his/her crate?

Is this Dog confined to a certain area of the house? or have run of the house? Please explain below.

Will the dog allow you or a stranger to examine his/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 detail below

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

Did you take this Dog to obedience training, if so where (name & phone # of Trainer)?

Please list any commands the dog has knowledge of:

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

Has the dog been Guard or Protection Trained? Remote collar (aka shock collar) trained?

If yes, please state where and when and by whom, or give more details.

Are you able to foster this dog until a foster or adoptive home can be found? If not, please tell us the last day that you could keep him.

We reserve the right to refuse acceptance of any Rottweiler. Acceptance is based on many criteria, one of which is space availability. If you are out of our area, we will pass on your surrender form to another rescue. I understand that the information contained in this form may be passed on to another rescue

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 also 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.

We MUST have proof of vaccinations, rabies, a recent heartworm test and proof of spay or neuter and 4 clear pictures of your dog. If and when your Dog is accepted into Rotten Rottie Rescue, and you cannot provide this proof, the $200.00 (or more depending on behavior issues and age and health of the dog) donation will be required. If you provide this proof, the requirement will be $50.00 and is expected at the time of your Dog’s evaluation and acceptance. If your rottie is pure bred and under 6 months old, the surrender fee will be waived. If you are having a hardship and can not afford the surrender fee, please discuss it with us.

Please email a minimum of 4 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, not sleeping. Best pictures are taken in the grass, in the day, with the dogs 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, 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.