Dog Rehoming Request Form

DOG REHOMING REQUEST FORM

If you need to re-home a Siberian Husky or Siberian Husky mix, please complete this form entirely. The accuracy of the information you provide is important in matching your dog with the right home. If you need to re-home more than one dog, please fill out a separate form for each dog and indicate in the comments section if they need to be placed together. If you are outside of our area (that is, eastern PA, NJ, DE, NY and northeastern MD), we may need to refer you to a local rescue. If you have any questions regarding this process, please email us.

Our group feels very strongly about trying to help out where we can. If you are encountering a behavior problem and wish to try and work things out, we'd be happy to try and help. Please email us and one of our volunteers will contact you as soon as possible.

Dog Information:

Registered Name (if available):

Call Name:

Sex:

Age:

Eyes:

Coat Color/Markings:

Is this a Purebred Siberian Husky or Siberian Husky Mix?

If your dog is a Siberian Husky Mix, please indicate what he/she is possibly mixed with:

What type of food is he/she being fed:

Dog's Living Situation:

Where does the dog spend the day? (check all that apply):

Loose indoors Crate Basement Garage Loose outdoors Tied up outside Kennel run Other

If other, please describe:

Where does the dog spend the night? (check all that apply):

Loose indoors Crate Basement Garage Loose outdoors Tied up outside Kennel run In bed with owner Other

If other, please describe:

How many hours on average does the dog spend alone weekdays (without humans)?

How many hours on average does the dog spend alone weekends (without humans)?

Personality:

Housebroken?

Comments:

Crate-trained?

Comments:

Trustworthy in the house alone?

Comments:

Get along well with other dogs?

Comments:

Get along well with small dogs?

Comments:

Get along well with cats?

Comments:

Well-behaved in a vehicle?

Comments:

Food aggressive with dogs?

Comments:

Food aggressive with people?

Comments:

Walk nicely on leash?

Comments:

Know basic commands?

Comments:

Good with young children?

Comments:

Have any specific fears?

Comments:

Does the dog do any of the following (check all that apply):

Dig Chew Jump up on people Escape Get up on furniture Counter-surf Beg at the table

List any bad habits:

Has this dog ever bitten a human or caused any injuries?

If yes, who and under what circumstance:

Has this dog ever bitten a another animal or caused any injuries?

If yes, who and under what circumstance:

Fence Information:

Dig out or try to dig out of a fence yard?

Comments:

What is the minimum fence height you'd recommend for this dog?

Comments:

Do you have a fenced in yard that the dog goes into?

If yes, please specify (check that apply):

Under 4 ft. 4 foot 5 foot 6 foot or higher Chain link Picket Invisible Privacy Other

If other, please describe:

If you have a fenced yard the dog goes into, does the dog escape that yard?

If the dogs escapes this yard, please explain how?

Health Information:

Medical History:

(indicate date of last shot or last test given)

Rabies:

DHLPP:

Bordetalla:

Lyme:

Heartworm Test:

Has this dog been spayed or neutered?

Date of Spay or Neuter:

Does the dog have any known medical problems (for example, allergies, arthritis, cataracts, dysplasia)

Veterinarian:

Do you have a regular veterinarian?

First name:

Last Name:

Organization:

Phone:

Is this the vet you currently use?

If this is not your current vet please explain:

Origination Information:

Where did the dog you need to re-home come from:

Breeder Shelter Rescue Owner Pet Store Other

If you indicated Other, please specify where you acquired this dog here:

If your dog was from a breeder, did you contact the breeder?

If your dog was from a rescue, did you contact the rescue?

If your dog was from a rescue or breeder and they would not take the dog back, please explain the reason given of why they would not take the dog back:

Origination Contact Information:

Please fill in the contact information of where this dog was acquired from:

Name of Breeder/Shelter/Rescue/Owner/Pet Store/Other:

Street Address:

City:

State:

Zip:

Phone:

Email:

Rehoming Information:

Are you the legal guardian of this dog?

If you are not the legal guardian, is the legal guardian aware you are filling out this form?

How long have you had this dog in your care?

What is the reason that you need to re-home your dog?

Please indicate the time frame in which you need to place your dog:

Contact Information:

Your Contact Information:

First name:

Last Name:

Street Address:

City:

State:

Zip:

Work Phone:

Best time to call:

Home Phone:

Best time to call:

E-mail:

Legal Guardian Contact Information:

(If the legal guardian is not filling out this form, please fill in their contact information here)

First name:

Last Name:

Street Address:

City:

State:

Zip:

Work Phone:

Best time to call:

Home Phone:

Best time to call:

Email:

Other Information:

Do you agree to allow TOTTSHR, Inc. to display your contact information and the information you have provided about this dog on our website and other advertising opportunities as TOTTSHR sees fit to help in re-homing your dog?

If No, why not?

Please indicate how you heard about about our organization:

If other, please specify:

Please let us know any other information you wish us to know in order to help with placing your dog.

By pressing the SUBMIT button, you attest that all of the information you have provided in this application is true and correct.

Please do not hit the SUBMIT button more than once. You will receive a confirmation page when your form has been processed and saved on the web server!

If you have any problems submitting this form please email us and make sure you describe what happened. You can also print out your application and mail it to: TOTTSHR, PO Box 612, Colmar PA 18915.

Thank you for taking the first step towards giving a second-hand dog first-class love.