Florida Brittany Rescue - Rehoming Form

** NOTES **

Sections can be filled out in any order, but there are required entries in each section.
You should figure on at least 30 minutes to complete this form.

Consent and Acknowledgment

Your Email Address:

	I/We certify the information I/we am/are providing in this form is accurate.
	I/We agree to relinquish all rights and ownership of my/our Brittany to the Florida Brittany Rescue.
	I/We hereby certify that, to the best of my/our knowledge, this dog has never bitten anyone in the past.
	It is my/our understanding that the Florida Brittany Rescue will make every effort to place the dog in an appropriate, loving home.
	I/We understand that by agreeing to accept my/our dog, Florida Brittany Rescue will incur costs relative to the care and lodging of my/our dog and that other costs will be incurred in advertising for a new home and screening prospective adopters.
	I/We understand that by making a donation to the Florida Brittany Rescue helps to cover the costs of medical care and boarding rescued dogs, while loving homes are found.

Dog's General Information

Dog's Name: Dog's Age: Dog's Gender: Microchipped?:

Microchip Number:

Dog's Medical Background

Spayed/Neutered?: Date of last vaccinations (best estimate): Shots given: Hold Ctrl (Cmd on Mac) to select multiple options. Other Vaccinations: Is the dog on a heartworm preventative?:

Name of heartworm preventative: Date of last heartworm pill (best estimate):

Veterinarian or Clinic Name (if known): Veterinarian or Clinic Phone Number (if known): Dog's diet is: Hold Ctrl (Cmd on Mac) to select multiple options. Other Food Type: Brand of food (if known): Dog's feed time is: Hold Ctrl (Cmd on Mac) to select multiple options. Any other Medical Conditions, Medications or Information:

Dog's Training and Temperament

Has the dog ever bitten a person?: Has the dog ever bitten another animal?: Describe the dog's temperament: House-trained?: Crate-trained?: Gets along with dogs?: Gets along with cats?: Gets along with children?: How many hours/day is the dog inside?: How many hours/day is the dog outside?: Where was the dog kept when home alone?: How many hours/day was the dog kept home alone?: How does the dog behave when home alone?: How was it confined when outdoors?: Does the dog jump fences?:

Fence Height: Fence Material:

Dog's Home Life

The dog has lived in the same household, at any time, with: Hold Ctrl (Cmd on Mac) to select multiple options. Any additional information about household co-residents: If applicable, how old where the children: Describe how the dog gets along with his/her current family: Describe the dog's behavior and habits: Hold Ctrl (Cmd on Mac) to select multiple options. Anything else we should know about the dog's behavior?: How does the dog react to strangers?: What is the dog's favorite activity?:

Reason for Rehoming

Why are you rehoming your dog?: How long have you had the dog?: Where did you acquire the dog?: Anything else we should know about the dog's history?:

Owner Contact Information

Owner's Full Legal Name: Owner's Email (if different from that provided in the first section): Phone Number: Phone Type: Home Address: City: State: ZIP Code:

Additional Information

Would you like updates?: Would you like us to contact you regarding making a donation?: Additional comments: