Surrender Form | Byron Dog Rescue

AGREEMENT OF SURRENDER

The more we know, the better we can match your dog with the right new home

Owner's Full Name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

How long has the dog lived with you?

Dog's Name

Dog's Age

Dog's Breed

Sex

Male

Female

Desexed

Yes

Microchipped

Yes

Microchipped Number:

Reason for Surrender

Where did you get this dog?

If from a breeder or rescue, name and location:

Have you contacted them about taking the dog back?

Yes

Have you contacted other rescue groups?

How long has the dog been left alone on a daily basis?

Tolerates time alone?

Yes

Where does the dog stay when home alone?

Where does the dog sleep at night?

Is the dog House Trained?

Yes

Crate Trained?

Yes

Has the dog ever been boarded or stayed with a pet sitter - details:

Training History:

Obedience

Agility

None

Other:

What commands does your dog know?

Walks on Leash:

Pulls

Loose Lead

Never walked

Protective/possessive of:

Food

Toys

People

Property

Destructive when alone?

Yes

If YES, please explain

Good with other dogs?

Yes

Selective

Has lived with other dogs?

Yes

Good with cats?

Yes

Unknown

Reaction to livestock?

Has your dog ever bitten anyone or another dog?

Yes

If YES, please explain

Has your dog lived with childen?

Yes

Could you specify ages of children?

Any issues with children and dog?

Reaction to loud play/yelling/sudden movements?

Vet visited regularly?

Yes

Current Vaccinations?

Yes

On any medications at present? Please specify

Any medical conditions, allergies or past injuries we should know about?

Medical and Vaccination Records (Upload files if available)

I understand that Byron Dog Rescue will make every effort to rehome the dog. By signing below, I agree to relinquish all ownership and rights to the dog as mentioned above. Please note that this is a legally binding agreement. Once you sign and return this form, along with the Change of Owner (NSW) form, Byron Dog Rescue will become the legal owner of the dog.

BDR assumes legal ownership of the dog as soon as the completed forms are received. Please remember that the dog will no longer be your property, and you must not hand it over to anyone except BDR. Even if you become aware of or know someone suitable who wishes to adopt the dog, you are not permitted to give the dog to them. They must apply for adoption through BDR.

Do not submit the Agreement of Surrender form unless you fully understand the legal implications of transferring ownership.

Relinquishing Owner to Sign:

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Date

Day

Month

Year