WeCare Rottweiler Rescue, Inc.
Owner Surrender Form

Response-O-Matic Form

 

When you have completed this form. Click on Submit when ready to send.

 

If you are surrending your Rottweiler due to a notice, you received from your insurance company, please visit AKC, Insurance Companies' Policies on Dogs You will find other Homeowners Insurance Companies who will except your Rottweiler. You do not have to give up your family pet for this reason.

Please keep in mind WeCare Rottweiler Rescue, Inc. cannot accept owner surrender Rottweilers from all over the United States. We will pass this form to a network of Rottweiler Rescue Organizations in hopes that a rescue near your location will be able to help you. You should also check Rottweiler Rescues in your area to see if they can take your Rottweiler.

WeCare Rottweiler Rescue, Inc. is a purebred rescue. We cannot accept Rottweiler mixes. Your Rottweiler requires the following:

  1. Current on vaccines
  2. Spayed or Neutered
  3. Have a heartworm check within the last 3 months OR
  4. The owner must make a $100.00 donation to WeCare Rottweiler Rescue, Inc.

Your surrender form will be considered by WeCare Rottweiler Rescue, Inc. and a decision will be made to determine if your dog will be accepted into WeCare Rottweiler Rescue, Inc. We will contact you shortly with the results of our decision.

You will also be requested to submit pictures of your Rottweiler, a front and side view to determine that the dog is definitely a Rottweiler.


IS YOUR DOG A PUREBRED ROTTWEILER? Yes No

If you checked NO, your dog is a mix breed, please do not go any further. We are unable to take mix breeds dogs into our program.

Personal Information


Name:

Address:

City: State:

E-Mail Address:

Phone:

Where is the dog located:

Rescued by me personally and is staying with me.

I own the dog and it is still with me at this time.

In a Shelter.   City:       State:  

At an Animal Control facility.  City:       State:  

Other Person: (specify)

If you have more than one Rottweiler to surrender, please fill out one application for each dog, making sure your name and email address are on each application.  If we have any further questions, we will contact you by email.

Information on Your Rottweiler

Please tell us why you want to Surrender your Rottweiler. Please be specific.



Name of the dog: Sex of the dog: Male    Female

Age of the dog: Date of Birth if known:

Age is unknown, but approximately:

Is the dog Spayed or Neutered? Yes No

Does the dog have a tail? Yes     No

Other Comments:



Please provide the following information to the best of your ability:

General History of Rottweiler

Where did you originally get, purchase or find the dog? Please be specific.



If you purchased the dog from a breeder, did you sign a contract giving the breeder right-of-first refusal? Yes     No

Breeder's name:  

Breeder's Phone Number:   

Have you contacted the breeder? Yes     No

If no, why not? Please be specific.



Is this dog AKC registered? Yes     No

Do you have the papers? Yes     No

Do you have a pedigree on this dog? Yes     No

Is the dog     an Inside Dog     an Outside Dog     Not Sure

Other Comments:



Medical History

If you are the present owner of this dog, please provide information about the dog's veterinarian:

Veterinarian's name:  

Veterinarian's Phone Number:

If the dog has not been spayed or neutered are you willing pay to have this done? Yes     No

Has the dog been tested for heartworm? Yes     No

If Yes, test was: Positive     Negative

If the dog has not been tested for heartworm are you willing to have this done? Yes     No

If the dog is heartworm positive are willing to pay for the heartworm treatment? Yes     No

Is the dog currently on heartworm preventative medication? Yes     No

If not, when was the last date that heartworm preventative was given?   

If yes, what brand of heartworm medication has the dog been on?

Is this dog current with it's vaccinations? Yes     No

If not, are you willing to pay to have all his vaccinations? Yes     No

Please provide other details of known/suspected medical conditions of this dog.



Other Comments:



Behavior

Is the dog housebroken?     Yes     No     Not Sure

This dog:     Needs to be confined to his/her crate.  Explain in box below.

Confined to a certain area of the house.  Explain in box below.

Has run of the house.

Explain:



Will the dog allow you to examine it's body without much trouble?     Yes     No

How does the dog behave around adults?

Friendly     Shy     Nervous

Difficulty with Men     Difficulty with Women

Other (specify):



Is the dog good around children? Yes     No

Is that experience: Good    or    Questionable

Has the dog ever bitten or snapped at anyone. Yes     No

If Yes, please explain & Please be specific.



Has the dog ever shown any aggression towards anyone or another animal? Yes     No

If Yes, please explain & Please be specific.



How does the dog behave at the vet?

Friendly     Shy     Nervous     Aggressive     Has to be Muzzled

Please explain & be specific.



Is the dog good and well socialized around:

Other Male Dogs Yes     No     Not Sure

Other Female Dogs Yes     No     Not Sure

Small Dogs Yes     No     Not Sure

Cats Yes     No     Not Sure

Other Small Animals Yes     No     Not Sure

Livestock such as Cows, Horses, Pigs, Chickens, Ducks Yes     No     Not Sure
If you checked No in any of the 6 boxes above to do with other animals.

Please explain & be specific.



Do you feel the dog is overly possessive about his food, treats or toys?     Yes     No

Please tell us about other behavior issues this dog may have.



Other Comments:



Training

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 had formal obedience training? Please explain.



Has the dog been Guard or Protection Trained?     Yes     No

Other Comments:



Are you able to foster this dog until a foster or adoptive home can be found?     Yes     No

I certify my Rottweiler is not an aggressive Rottweiler nor has never had even 1 bite history. If my Rottweiler has had an aggressive/bite history and I do not information WeCare Rottweiler Rescue, Inc. of the aggressive behavior/bite history and said Rottweiler is adopted causing injury of aggressive behavior/bite, then I can be held responsible. Yes No

How did you hear about WeCare Rottweiler Rescue, Inc.?



Yes No

Space for additional comments:



Have You read the link, "Thoughts of surrendering your Rottweiler, please read this message first".
    Yes     No

I certify that the information provided on this form is true & correct.  I understand that an evaluation of the dog, and a temperment test will be performed by an experienced rescue volunteer. This allows us to ensure we feel the dog is rehomeable before we accept this dog at WeCare Rottweiler Rescue, Inc. If during the evaluation process we find information contained in this surrender form to be false, we retain the right to turn down acceptance of the Rottweiler you are surrendering.
Yes     No

I understand that the following criteria must be met before WeCare Rottweiler Rescue, Inc. will consider taking my Rottweiler as a owner surrender. I understand that if I am not able to meet these prerequisites, I have explained above will be taken into consideration by WeCare Rottweiler Rescue, Inc. in determining the acceptance of my Rottweiler as an owner surrender.

  1. Current on vaccines
  2. Spayed or Neutered
  3. Have a heartworm check within the last 3 months OR
  4. The owner must make a $100.00 donation to WeCare Rottweiler Rescue, Inc.
    Yes     No

I agree to have proof of vaccination, rabies, neutered and heartworm test. If you cannot provide this proof the $100.00 donation will be required.
    Yes     No

Signature:

Please only click once. There may be a short delay before your information is sent.



WeCare Rottweiler Rescue, Inc.
P.O. Box 690
Deleon Springs, FL 32130

Email: wecarerotti@bellsouth.net