Majesty Rottweiler Rescue Owner Surrender Form

Majesty Rottweiler Rescue Inc. Owner Surrender Form

If you are in need of surrendering your dog or know of a homeless dog in need of our help please fill out this owner surrender application and e-mail it to: [email protected] or by US postal service to; Majesty Rottweiler Rescue ~ P.O. Box 493 ~ Darlington, Md 21034-0493. Please know any dog surrendered must go through the proper protocol in order to be accepted into Majesty Rottweiler Rescue.

Your Dog must be current on vaccines, Spayed/Neutered, heartworm negative and on preventative and micro chipped before any adoption is possible. If not the owner must make a $200.00 surrender fee to Majesty to help us recover some of the cost of preparing your Dog for adoption. If you are unable to meet these prerequisites, please explain more about your situation here, and then continue to complete the rest of this form. Majesty will consider your circumstances, and a decision will be made to determine if your dog will be accepted into Majesty. It may take several days for us to get back to you with the results of this decision, please be patient. If any questions are left un-answered, this form will NOT be considered. It is extremely important that you answer all questions and answer them truthfully.

You are also requested to submit pictures of your dog, preferably a front and side view to determine that the dog is definitely a Rottweiler. If you have more than one dog to surrender, please fill out one application for each dog, making sure your name and email address is on each application. If we have any further questions, we will contact you by phone or by email.

Please Note: Fill in your name, E-Mail Address along with your home address including your City, State and zip code, if you do not, you will not receive a reply from us. Also if any questions are left un-answered, your request will not be considered.

Your Name: Address: E-Mail Address: Phone:

Information about the Dog

Name and sex of the Dog?

Age of the dog: Date of Birth if known:

Please tell us why you are surrendering this dog, and please be specific.

If age is unknown, approximate age of the Dog?

How much does your Dog weigh?

What food (brand name) are you feeding your Dog, how much and how often?

Does the dog have a natural tail? Where is the dog located?

Do you own the dog and have him/her with you at this time? If this is not your Dog please explain in detail and give the name and phone number of the current owner;

History of Dog (Please provide the following information to the best of your ability)

How long have you had this Dog?

Where did you originally purchase/find or adopt the dog?

If you purchased the dog from a breeder or was adopted did you sign a contract giving the breeder right-of-first refusal?

Please give the name of the Breeder, Rescue or Shelter where you purchased or adopted this Dog?

Breeder, Rescue or Shelter Phone Number?

Have you contacted the breeder/shelter/rescue?

If no, why not? Please be specific.

Is the dog an inside Dog or an outside Dog?

Medical History

If you are the current owner of this dog, please provide information about the dog's veterinarian: (very important to provide in order to not over dose your dog with vaccines and we must have proof of shots, spay/neuter) If you don’t have copies of this, you may ask your Vet to fax them to us at: (206) 350-7688

Veterinarian's name and phone #:

Is the Dog Spayed or Neutered? If yes please provide proof of this in writing from your Vet, a certificate or copy of bill showing it was done.

If the dog has not been spayed or neutered are you willing pay to have it done?

Is the Dog micro-chipped or tattooed, if so what is the number?

Date when this dog was last tested for heartworms?

Did your Dog test positive or negative?

If the dog has not been tested for heartworms are you willing to have this done?

If the dog is heartworm positive are you willing to pay for the heartworm treatment?

Is the dog currently on heartworm preventative medication? When was the last dose given? If yes, what brand of heartworm medication has the dog been on?

Is this dog current with his/her vaccinations?

If not, are you willing to have the dog updated on his vaccinations?

Has the Dog been x-rayed for Hip Dysplasia?

If so, do you have the certification that he/she is Hip Dysplasia free from your Vet?

Please provide other details of known or suspected medical conditions of this dog, anything you provide us will only help us to help your Dog sooner. Please know we are aware some Dogs are given away because they have been diagnosed with a disease or health problem, that does not in any way mean we will not take them, please help us to help your Dog, by being completely candid with us.

Behavior

Is the dog housebroken?

Does this Dog need to be confined to his/her crate? If so, please explain in detail below;

Is this Dog confined to a certain area of the house? Please explain below.

Has run of the house? If not please explain:

Will the dog allow you to examine his/her body without much trouble?

How does the dog behave around adults? Friendly Shy Nervous

Difficulty with Men? Difficulty with Women? Difficulty with Children? Other (specify):

Is the dog good around children under 5 years of age?

Has the dog ever bitten or snapped or bitten anyone? If yes, please explain & be specific, was it reported?

Has the dog ever shown any aggression towards anyone or another animal? If yes, please explain and be specific.

How does the dog behave at the vet? Friendly Shy Nervous Aggressive Needs to be muzzled? If yes, please explain & be specific.

Is the dog good and well socialized around? Male Dogs? Female Dogs? Small Dogs?

Cats? Other Small Animals? Livestock (Cows, Horses, Pigs, Chickens, Ducks)?

If you answered no to any of the 6 questions above, please explain & be specific.

Do you feel the dog is overly possessive about his food, treats or toys? If yes, please explain in detail below;

Please tell us about any other behavior issues this dog may have, please know your dog will have to pass a temperament evaluation in order to be accepted into our rehoming program.

Training

Did you take this Dog to obedience training, if so where (name & phone # of Trainer)?

Please list any commands the dog has knowledge of:

When on a leash, do you walk the dog, or does the dog walk you?

Has the dog been Guard or Protection Trained?

Are you able to foster this dog until a foster or adoptive home can be found?

How did you hear about Majesty's Rottweiler Rescue?

We reserve the right to refuse acceptance of any Rottweiler. Acceptance is based on many criteria, one of which is space availability. If you are out of our area, we will pass on your surrender form to another rescue. I understand that the information contained in this form may be passed on to another rescue; Yes? No?

I certify the information provided on this form to be true & correct. I understand that a physical evaluation of the dog, and a temperament test will be performed by an experienced rescue volunteer to ensure we feel the dog is re-homeable before my Dog is accepted into Majesty's program. If during the evaluation process we find the information contained in this surrender form to be false, we retain the right to turn down acceptance of the dog you are surrendering. I also understand the following criteria must be met before Majesty will consider the acceptance of my Rottweiler. I also understand if I am not able to meet these prerequisites, Majesty will take into consideration my circumstances which I have explained above in determining the acceptance of my Rottweiler.

We MUST have proof of up to date vaccinations, rabies, a recent heartworm and fecal test along with proof of spay or neuter, microchip # and pictures of your dog. If and when your Dog is accepted into Majesty, and you cannot provide this proof, the $200.00 rehoming fee will be required. If you provide this proof, the requirement will be $50.00 and is expected at the time of your Dog’s evaluation and acceptance into Majesty.

Signature: ______Date______

Signature of Majesty Representative: ______

Please send a copy of all health records along with a signed copy of this form and at least one picture of your Dog, to Terry at the address below or you may e-mail it to [email protected] If you do not send a COPY of the health records with this application and you have not stated the reason on this form, your application will not be considered.

Please send forms to: Majesty Rottweiler Rescue Inc. P.O.Box 493 Darlington Md 21034-0493