Staffies-In-Need - Surrender Information Form
Surrender Information Form

Please complete this form giving as much detail as possible.

This form is purely for us to obtain information about the dog in question.

Staffies in need will contact you if a space becomes available and it is possible to arrange your dog(s) for rehoming. The dog(s) will be placed on a fostering/ adoption list.

By completing this form, you are agreeing to keep Staffies In Need informed, especially if you no longer need assistance. If you do not maintain regular contact, the dog(s) may be removed from the waiting list. If we agree to take your dog(s) then after we have received this Surrender Information Form there will be one other form you must sign.

Staffies In Need uses a network of friendly and loving foster carers, who will be able to offer your dog a secure home until we have found their forever home. By signing this form, you agree you have been made fully aware your dog may be passed to a third party and that although we keep in regular contact with the foster carers, Staffies In Need are unable to give further information as to which third party the dog has been passed to.

By completing this form, you are giving your permission for Staffies In Need to display information and pictures of your dog to the public whilst finding a suitable adoptee/foster home.

Staffies In Need will display this on their social media pages and contact you when a possible adopter/fosterer becomes available. All adopters and their properties will have been assessed by Staffies In Need to ensure the dog is receiving the best and safest care. When an adopter becomes available this will then entail us making transportation arrangements . If you do not have a car, we can provide transport for you. All arrangements will be made through Staffies In Need and you will be informed of these.

In extreme cases, if possible, Staffies In Need will organise for a fosterer to collect your dog from your property to ensure the dog is kept safe and well looked after until we can provide them with their adopter. These extreme cases will have to be assessed by Staffies In Need to determine if placing the dog in foster care is needed or possible.

Once you have surrendered your dog and have filled out the paper work the dog will be in staffies in need care.
Name Of Owner *
Your answer
Postcode *
Your answer
House Number and Street Name *
Your answer
City/Town *
Your answer
Owner Phone Number *
Your answer
Owner Email Address *
Your answer
Dogs Name *
Your answer
Dogs Breed *
Your answer
Dogs Age *
Your answer
Dogs Sex *
Your answer
Dogs Coloring/Markings *
Your answer
Has the dog been Neutered? *
Your answer
Is the Dog Microchipped? *
Your answer
If yes can you please provide the michrochip number *
Your answer
Has the dog been vaccinated? *
Your answer
If yes on what date? *
Your answer
Can you provide the vaccination card? *
Your answer
Has the dog been wormed? *
Your answer
Has the dog been flea treated? *
Your answer
If they have been wormed or flea treated when was this? *
Your answer
How long have you had the dog? *
Your answer
Name of vet/surgery *
Your answer
Vets Name *
Your answer
Vets Address *
Your answer
Vets Phone Number *
Your answer
Where did you get the dog from? *
Your answer
Is the dog house trained? *
Your answer
Does the dog have training already? *
Your answer
If yes what training have they done, What skills do they have? *
Your answer
Does the dog need training in specific areas? *
Your answer
Is the dog destructive? *
Your answer
Is the dog sociable with other dogs, Different ages or sexes? *
Your answer
Is the dog sociable with cats? *
Your answer
Has the dog ever shown any signs of aggression or bitten anyone whilst in your care? *
Your answer
Has the dog shown any aggression with food or toys in the past? *
Your answer
Is the dog happy being touched on the nose or behind the ears? *
Your answer
If no please state the areas he/she doesn't like being touched in *
Your answer
How many hours can the dog be left alone for? *
Your answer
Does the dog travel well in a car? *
Your answer
Is the dog sociable with adults? *
Your answer
Is the dog sociable with children? *
Your answer
If yes what ages? *
Your answer
Does the dog have any medical conditions? *
Your answer
If yes please provide details of the conditions *
Your answer
Is the dog on any medication? *
Your answer
If yes please give details *
Your answer
Is the dog receiving any ongoing vet care? *
Your answer
If yes please provide details *
Your answer
Has the dog received any vet care in the last 6 months and if so what for? *
Your answer
If yes what vet care did the dog receive? *
Your answer
How does the dog respond at the vets? *
Your answer
In your opinion what kind of home would be suitable for the dog? *
Your answer
What are your reasons for rehoming the dog? *
Your answer
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