Owner Surrender Application

Owner Surrender Application

Please complete this application in full. Incomplete applications will not be processed. NERR&R is under no obligation to accept any Rottweiler into its care.

Current Owner Information:

Name: ______

Address: ______

City: ______State: ______Zip Code: ______

Phone Number: ______Alt. Phone: ______Will you accept a collect call?

Best time to call? ______E-mail Address: ______

How did you hear about North East Rottweiler Rescue and Referral Inc.? ______

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Rottweiler Identifying Information:

Name:______AKC Registration: ______

Name and contact information for your Rottweiler’s Breeder: ______

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Date of Birth: ______Sex: ______Spayed/Neutered? ______

Tail Docked? ______Tattooed/Microchipped? ______

Rottweiler Health Profile: (medical records must be provided before surrender)

Rottweiler’s Veterinarian and contact information: ______

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Name of client your dog is listed under at veterinarian: ______

Is your Rottweiler currently vaccinated? _____ Date of last veterinary appointment: ____

Date of last heartworm test: ______Which brand of heartworm preventative is your Rottweiler currently taking? ______Date of the last dose: ______

Date of last Lyme Dz test: ______Is your Rottweiler vaccinated against Lyme Dz? ____

List any major medical conditions or surgeries your Rottweiler has ever had: ______

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Rottweiler Personality Profile: (please be as detailed as possible)

Has your Rottweiler bitten, nipped or snapped at a person? ______

Does your Rottweiler bark or growl aggressively at people or other animals? ______

Is your dog shy or afraid of anything? ______

Describe your Rottweiler’s temperament? ______

Has your dog lived with children? ______Ages? ______

Is your dog good with children? ______

Has your dog lived with other animals? ______What kind? ______

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Is your dog good with cats and small animals? ______

Is your dog good with other dogs? ______

Has your dog ever fought with another dog or animal? ______

Is your Rottweiler crate trained? ______Housebroken? ______

Where does your dog stay when left alone? ______

Does your dog have any destructive habits? ______

Does your dog like car rides? ______

What are some activities your Rottweiler likes? ______

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What are some activities your Rottweiler dislikes? ______

Has your Rottweiler had any formal training? ______

Has your dog ever been protection trained? ______

Can you disturb your dog when he is eating? ______Sleeping? ______

Playing with toys? ______Does your dog guard any persons or objects? ______

Describe your Rottweiler’s activity level: Very High High Medium Low Very Low

What brand of food and what quantity does your dog eat? ______

What type of home would you feel would best suit your Rottweiler? ______

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Character References: (please provide complete contract information for three different people who are personally familiar with your Rottweiler’s character)

Reference 1: ______

Reference 2: ______

Reference 3: ______

Additional Comments? ______

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______

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I certify that the information provided on this form is true and correct. I understand that by providing this information, I am under no obligation to relinquish my Rottweiler to NERR&R nor is NERR&R under any obligation to accept my Rottweiler.

Signature of owner: ______Date: ______