Surrender Form Surrender Form Sometimes, no matter how hard we try, we are forced to give up the wonderful dogs we love. If you would like CHAR's help with your Aussie, please fill out this surrender form. This gives us an idea of the dog you need help with. Your Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Dog's Name*Breed*Age*ColorGender* Female Male Spayed or Neutered?* Yes No Do you legally own this dog?* Yes No If you are not this dog's owner, please list the owner's name and contact information, and why you are helping them rehome their dog.Are you legally permitted to rehome this dog?* Yes No How long have you owned this dog?*Where does this dog live?* Inside your home Outside in a kennel/run/fence Outside tethered/chained Is this dog up to date on vaccinations and heartworm preventatives?* Yes No Please provide the name, address, and phone number of the veterinarian where the dog has received its medical care.When was the last time this dog saw a vet?*Where did you get the dog?* Breeder Rescue Pet Store Individual Other If you purchased the dog from a breeder, please provide their name and phone number (or email) if you can.Has this dog ever bitten a person?* Yes No Does this dog exhibit aggression with people (growling, snarling, snapping, lunging, etc.)* Yes No Does this dog exhibit aggression with other animals (other dogs, cats, livestock, etc)?* Yes No If yes, please explain what types of aggression and toward what animals.Is this dog good with cats?* Yes No Unknown Is this dog good with children?* Yes No Unknown Is this dog good with women?* Yes No Unknown Is this dog good with men?* Yes No Unknown Is this dog good with strangers?* Yes No Unknown Is this dog house trained?* Yes No Is this dog crate trained?* Yes No Has this dog had professional training?* Yes No If yes, please explain what types of training and what commands the dog is familiar with.Does this dog have any behavioral problems?* Yes No Please list any behavioral problems the dog may have (separation anxiety, fearful, bolts through doors, nuisance barking, fence jumping, etc.)Describe anything this dog is fearful of.Does this dog have any health problems?* Yes No If yes, please explain what types and whether they have been treated by a veterinarian. Please include any medications (other than monthly preventatives) that the dog is taking.Describe this dog's personality and energy level.*Why do you need to rehome this dog?*Is there anything you would like to add to this surrender application for our consideration?We are a rescue that operates solely off of donations. If this dog is accepted into CHAR, will you be willing or able to make a donation toward the care of this dog? Even if a dog is completely vetted with no health problems, our rescue still incurs costs of food, preventatives, travel, etc.* Yes No Your answer to this question will not have any affect on whether we decide to accept this dog into our rescue or not.I have read the dog surrender policy and agree to the terms of surrender explained in the policy.* Yes No If you have not read the owner surrender policies, please do so before submitting this form. If you do not read and agree to the conditions, we will not be able to take your dog into our care.PhotosPlease attach up to three photos of the dog you wish to surrender below. As we are a breed-specific rescue, we can only take dogs that are confirmed to be herders. Providing photos beforehand will allow us to determine up front if your dog is applicable for our rescue. Dog Photo 1Dog Photo 2Dog Photo 3Captcha
