Gifted Dog Form Please fill in the form below if you need to hand your dog over to us. A member of the team will be in touch in due course. Please note our waiting list for gifted dogs is currently closed while we process backdated applications. Gifted dog form Name * Name First Name First Name Last Name Last Name Address * Address line 2 Postcode * Phone number * Email Dog Name Breed * Colour Dog age (DOB if known) Is the dog microchipped? * Yes No Unknown Is the dog microchipped to you? * Yes No Unknown Microchip Number (if known) Is the dog vaccinated? * Yes No Unknown Is the dog Neutered? * Yes No Unknown Is the dog up to date with flea treatments? * Yes No Is the dog wormed up to date? * Yes No If your dog is fully vaccinated, please attach a copy of their vaccination record here. We are able to prioritise fully vaccinated dogs due to not having to isolate them which means we may be able to get your dog in quicker. Drop a file here or click to upload Choose File Maximum file size: 67.11MB Reason for bringing your dog into our care? * Where did you originally get the dog? * How long have you owned the dog? * How many previous homes has your dog had? How many adults live in your home? How many children live in the home? Please provide ages How does your dog react around children? How would you describe your home environment? e.g. busy, quiet, children visiting Describe how your dog reacts when meeting other dogs outside of the home? * Has your dog lived with other dogs? Yes No How many dogs have they lived with? How many dogs are being rehomed? If multiple dogs are being rehomed are they related? Yes No Where does each dog prefer to spend their time? Do the dogs ever play together? Yes No If yes, please describe how they play together Is there ever any aggressive behaviour displayed between the dogs? Yes No If yes, please provide as much detail as possible? Is there ever any resource guarding between the dogs? i.e. beds, food, toys Yes No If yes, please provide as much detail as possible How do the dogs prefer to spend their time when they are together in the same room? e.g. playing, sleeping, avoiding each other Do the dogs sleep physically touching each other? Yes No Has the dog ever lived with cats? * Yes No How does the dog behave around the cat? The dog and cat must be kept separate The dog will chase the cat if the cat moves The dog avoids the cat The dog is uninterested in the cat The dog interacts calmly with the cat Does the dog have any ongoing medical conditions? * Yes No If yes, please provide a details Is the dog currently on any medication? * Yes No If yes, please provide a list of medication and dosage Does the dog have any known allergies or special diet requirements? * Yes No If yes, please provide full details Are there any previous medical concerns or injuries we should be aware of? * Yes No If yes, please provide full details Please provide the name and address of your veterinary practice How does your dog behave in the home enviroment? * Does not come in the house- kennelled outside Spends all of their time around people in the home Spends some time around people in the home but prefers to be alone Does not like new people coming in the home Confident, is happy for people to come into the home Other Please provide any details you feel may be relevant Are there parts of your dog's body they do not like to be touched? * Yes No If yes, please provide full details Where does your dog sleep both day and night? * Does your dog like to play with toys? * Will not play with toys Will play if encouraged Will occasionally play with toys Plays with toys regularly What type of toys does the dog like to play with? Does your dog Know any commands/phrases? * Sit Lie down Stay Other Please provide as much information as possible about know commands Has your dog ever bitten? * Yes No If yes, please provide full details Does your dog get overexcited and scratch or bite during play? Yes No If yes, please provide full details Have fingers or toes, hands or feet ever been used as toys for your dog? Yes No If yes, please provide full details Has your dog ever been crate trained? Yes No If yes, please provide full details Has your dog ever been to a groomer? Yes No If yes, please provide full details Does your dog currently or have they previously displayed any of these behavioural problems? scent marking or urinating in the home Aggressive behaviour to members of the household Aggressive behaviours towards visitors or other people Vocalisation throughout the night Issues with other dogs in the home Issues with other pets in the home Excessive hiding Chewing non-food toy items Overgrooming Aggressive behaviour when on walks Resource guarding e.g food, toys etc Other please specify Please provide full details for any ticked boxes If your dog has ever displayed any of the above behaviours, have they been to a vet for the behavioural concern? Is your dog frightened of anything? Fireworks Thunder or inclement weather Vacuum cleaner Toddlers/children Visitors / strangers Other dogs Other animals Vets Other please describe: How does your dog usually respond when frightened? What and when does your dog currently eat? please include type of food i.e., wet or dry, brand, time and frequency of feed * Are there any foods that your dog dislikes or is sensitive to? Yes No If yes, please provide full details What type of food and water bowls does your dog use? (e.g. ceramic, metal, plastic, slow feeder other) Is your dog fully house trained? * Yes Will have occasional accidents No If yes, please provide full details Where does your dog prefer to toilet? On walks On grass On concrete In the garden/ yard Other If Other, please provide full details If your dog in not house trained, where do they toilet? How would you best describe the outside environment the dog is used to? Rural Semi-Rural Quite town Busy town Other If Other, please provide full details Please provide any further information about your dog that you feel may be relevant Please attach a photo/s of your dog here. Drop a file here or click to upload Choose File Maximum file size: 67.11MB Please tick if you are happy to receive further information from/about the shelter by: * Email Post Telephone SMS Message None of the above Captcha Submit If you are human, leave this field blank. Δ
