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Waiting List Form
What is you email address? *
Your answer
What is the name of the dog? *
Your answer
Is the dog a full staffy or a cross? *
Your name *
Your answer
Your address *
Your answer
Your postcode *
Your answer
Your telephone number (land line and mobile if available) *
Your answer
Is the dog male or female? *
What is the age of the dog? *
Your answer
Is the dog spayed / neutered / entire? *
Required
Please note, we do NOT rehome un-neutered / un-spayed dogs unless it is on vet advice. If your dog is not neutered or spayed we will ask for a donation towards the cost of this, or you can have this carried out at your own expense prior to the dog coming into our care.
If an entire bitch, when was she last in season?
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If an entire bitch, has she ever had pups?
If she has had pups, when?
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If an entire male, was he ever used as a stud?
The dog's main coat colour? *
Your answer
The dog's coat condition? *
Your answer
Is the dog vaccinated? *
If vaccinated, please provide the vaccination date, and we will ask you for a photocopy of the records.
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Any boosters due? *
Is the dog known to be good with children? *
If good with children, give an age range that the dog is used to
Your answer
Is the dog known to interact well with other dogs? *
Is the dog known to interact well with cats or other pets? *
Has the dog been known to chase or attack livestock (sheep, cows etc), whether playfully or not? *
Has the dog ever shown signs of aggression? *
Has the dog ever bitten anyone? *
If the dog has bitten, please give brief details of the circumstances and outcome.
Your answer
How does the dog react to strangers in the home? *
Your answer
Does the dog have a chewing habit when left alone? *
Is the dog used to travelling, and by what means? *
Your answer
Does the dog bark excessively? *
Has this dog ever lived with other dogs? *
How old was the dog when it became your responsibility? *
Your answer
Where did you obtain the dog from? *
Your answer
Please give details of the dog's feeding regime *
Your answer
What brand of food / diet is the dog used to? *
Your answer
Are there any food allergies you are aware of? *
Your answer
Is the dog used to having a bath? *
Is the dog used to having its teeth cleaned? *
Is the dog used to being kept indoors? *
Please give details of the dog's microchip or tattoo number *
Your answer
Is the dog house trained? *
How does the dog express a need to be let out for toilet etc? *
Your answer
Is the dog lead trained? *
Has the dog been to obedience classes? *
Has the dog had medical issues in the past? If so, please give details. *
Your answer
Are those problems ongoing, or are there current medical problems we need to know about?
Your answer
How does the dog react to vets / treatment? *
Your answer
Is there a pedigree? *
Please give details of your vet's address and telephone number *
Your answer
Please answer honestly, the reason why you need to rehome the dog. *
Your answer
Are there any known issues with food or toy aggression, with other animals or people? *
Is there any other information you wish to give us, that could cause concern in a new home? *
Your answer
Is there any other information we can offer to new owners should we re-home your dog, for example likes / dislikes / favourite toys etc? *
Your answer
If you have your own transport, would you be willing to travel to help us out if necessary? *
Is the dog registered with any other re-homing agencies? *
We must be told the truth about your dog/dogs. If at a later date we discover that information has been withheld, which leads to unexpected behaviour in its new home, for example being aggressive towards people or animals, or the dog causes injury to any person or animal, we at Senior Staffy Club cannot be held liable. If the new owner seeks prosecution we will give them information as to the whereabouts of the previous owner. Please enter your full name to agree to these terms. *
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