Surrender Request - Aussie Rescue of Minnesota

Aussie Rescue of Monnesota - Surrender Request

Thank you for your interest in Aussie Rescue of Minnesota.

Our goal is to match your dog with its new forever home as quickly as possible. To accomplish this, we proactively request a lot of information to help us ensure we have the right match from the start, therefore increasing the chances of finding a perfect home the first time and limiting the number of times your dog has to transition to a new life. There are no right or wrong answers to our surrender request form. We do not judge you based on your answers. We just ask for you to provide the truth so we can accomplish the goal – realign your dog to a new forever home the first time and do so with the least amount of transitional stress. Thank you for taking the time to complete this surrender request form.

Please make sure that you have all the necessary information at hand before completing this form (i.e., 4 photos – front, back, left side, right side – of your dog, traits, behavior, vet info).

Owner Information

Name

Address

City

State

Zip Code

Best Contact Phone

Time Deadline to this Surrender (We have a waiting list and limited foster availability)

Dog Information

Dog Name

Dog Age
years months

Breed

Dog Sex MaleFemale

Spayed/neutered YesNo

Weight (lbs)

Markings/Color/Coat length

Reason for Surrender

What actions have you taken to address your reason to surrender? (check all that apply)
Professional one-on-one trainingClass setting trainingIncrease in mental workIncrease in physical exercise

How long have you had this dog? Where did you get it?

Vet Information

Vet Clinic

Vet Name

Vet Phone Number

Date of last Rabies Vaccination

Date of last Parvo Vaccination

Date of last Distemper Vaccination

Has your dog been microchipped? YesNo

If microchipped:

Microchip Number

Microchip Organization

Dog Bite History

Has your dog ever bit a human? YesNo

If yes, please explain:

Has your dog ever bit another dog/animal? YesNo

If yes, please explain:

Has your dog displayed aggression? YesNo

If yes, please explain:

Has your dog ever attacked/attempted to attack a person? YesNo

If yes, please explain:

Please check all boxes for traits that apply to your dog:

CalmAffectionateAgileAnxiousCuriousNervousRambunctiousCuddlyPatientFunPlayful with humansPlayful with DogsHyperSleepyVocal/BarkerWatchfulFriendly with humansFriendly with dogsRespectfulRough playerGentle playerObedientAggressiveStubbornComicalLoyalVelcroJumps upon greetingCounter SurferEnjoys the outdoorsHas off switchReactive on a leashWell socializedDigger

On a scale of 1-5, my dog is:
1 = needs significant work
5 = outstanding

Good with human strangers? 12345No Exposure
Good with other dogs? 12345No Exposure
Good with cats? 12345No Exposure
Good with livestock? 12345No Exposure

My dog does well with:

Women YesNoNo Exposure
Men YesNoNo Exposure
Kids age 0-5yr YesNoNo Exposure
Kids age 6-11yr YesNoNo Exposure
Kids age 12-15yr YesNoNo Exposure
Kids age 16-18yr YesNoNo Exposure

What is your dog’s energy level? LowMediumHigh

What is your dog’s prey drive? LowMediumHigh

Resource Guarding

Does your dog guard resources? YesNo

If yes, do they guard toys? YesNo
If yes, do they guard food? YesNo
If yes, do they guard people? YesNo
If yes, do they guard other dogs? YesNo

Dog Traits

Is your dog Crate trained? YesNo
Is your dog House trained? YesNo
Is your dog Good on a leash? YesNo
Is your dog Obedience trained? YesNo
Is your dog Good with other dogs at doggy daycare/dog parks? YesNo

How does your dog spend the day?

In a crate YesNo
Roaming the house YesNo
Outside YesNo

Fence/Secure Yard

Does your dog need a secured (fenced-in) yard? YesNo
If yes, would they escape a 4’ fence? N/AYesNo
If yes, would they escape a 5’ fence? N/AYesNo
If yes, would they escape a 6’ fence? N/AYesNo

What kind of fencing do you have right now? (Enter N/A if you do not have a fence)

Additional Information

Any additional health issues we need to know to ensure highest quality of care for your dog in its new forever home (include current medication name, dose, and frequency) (please enter "N/A: into field if no additional health issues):

Any additional information that would be useful to quickly find your dog its new forever home: (please enter "N/A: into field if no additional information)

Dog Photos

Please attach 4 photos of your dog (front, back, left side, right side - the limit is 2 MB for each photo). All 4 photos are REQUIRED.

Front Photo:
Back Photo:
Right Side Photo:
Left Side Photo: