UK Boston Terrier Rescue Surrender Form

Questions are essential for records, both statutory and our own, and to aid us in our assessment process; we cannot stress how important it is that ALL questions are answered as truthfully and in as much detail as possible; this is not to judge you but rather ensure we have as much information as possible about every dog surrendered to us to enable us to meet their needs and match them as safely and appropriately as we can with a foster family. There is nothing you can tell us that will put us off.

Dog’s Name:
DOB / Age:
Reason for surrender:
Breed:
Colour:
Age:
Sex:
Neutered: Yes/No (If no, date of last season if a bitch):
Date last wormed:
Date last flea treated:
Date last vaccinated:
Card present? Yes/No
HISTORY
Does the dog have any History of Illness/Operations? If so, what and when:
What age was this dog when you got him/her?
Where did you get him/her from? Breeder/Pound/Rescue
If Rescue or Pound which one?
Does the dog legally belong to you? Yes/No
Approximately how many owners has he had?
Do you know much about his past? Please explain:
BEHAVIOUR
Used to Children Yes/No if yes what ages?
Used to Cats Yes/No
Other Furries? Yes/No
Does he exhibit any aggressive tendencies?
Towards Dogs? Yes/No If so, is he/she aggressive to Male/Female dogs?
In what circumstances?
Human aggressive? Yes/No If yes, in what circumstances?
CURRENT REGIME
Exercise:
How often and for how long is your dog exercised daily? (Be as honest as possible no one is criticising you - it is essential so we know how much exercise to give your dog initially)
Is your dog let off lead?
Recall?
Is your dog used to being left? If so, for how long?
Where is he kept when left?
Does he exhibit any destructive tendencies? If so lease give details:
Feeding:
What food do you use?
How much do you give at each mealtime?
What times of day is your dog currently fed?
Sleeping Arrangements:
Where does your dog currently sleep?
Does he have his own bed? Yes/No
Will you provide his bed? Yes/No.
Is he crate trained?:
Any other information you feel would be useful:

me

I have read and understand that this is a legally binding agreement between myself as current owner of the aforementioned dog and UK Boston Terrier Rescue and I hereby transfer ownership of the dog to UK Boston Terrier Rescue.

Vet’s Name, Address and Telephone No:

I give permission to above mentioned vets to pass on veterinary records for my dog if requested.

*ESSSENTIAL: If microchipped:
Microchip Number & Company:
If tattooed: Tattoo number & Company:
In whose name/s is the dog microchipped?

Signed (ORIGINAL OWNER):

Date:

Name (BLOCK CAPITALS):

Address:

Telephone No:

Signed on behalf of the Rescue:

Date:

Rep’s Name (BLOCK CAPITALS):

UKBTR:

Donation:

IMPORTANT Before surrendering your dog to rescue/rehab, we would ask you to think long and hard about your reasons and to be absolutely certain that this is the step you wish to take. Once surrendered to us the dog becomes our property legally and the step is irrevocable.

This form must be completed and returned with vaccination card, microchip certificate, and any other documents prior to the handing over of the dog. This is to ensure that documents do not go amiss on transport runs; we thank you for your cooperation in this matter.

Please email this form in the first instance to: