Name *Street AddressPost CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweEmail Address *Phone NumberDog's NameDog's BreedDog's Date of BirthSexMaleFemaleNeuteredYesNoChemical castrationMicrochippedYesNoChemical castrationWeight of the dog (in kg)Are the dogs vaccinations up to date?YesNoIf yes, please provide date of last vaccinationHow long have you had the dog?Where did you get your dog?If from a breeder or rescue, do you have a breeder or rescue contract in place?YesNoChemical castrationIs the dog house-trained?YesNoChemical castrationWho currently lives at home with the dog? Please give details of all adults & children, including agesDoes, or has, the dog lived with other dogs?YesNoIf yes, please give details:Has the dog lived happily with cats?Has the dog lived happily with other small animals?Is your dog registered at a vet? If yes, please give name, address and phone number details belowHas your dog any long term illness? If yes please disclose what the illness is (this does not in anyway stop us taking your dog) and list any medication your dog is onIs your dog currently seeing your vet for any medical issues, if yes please state what. (this does not affect us taking your dog) and list any medication your dog is currently takingDo you give TSPP permission to contact your vet?YesNoHave you contacted a vet or professional organisation regarding your dog's behaviour recently or in the past?Have you been in touch or spoken with any other rescue/rehoming centres/ organisations?What are your reasons for rehoming?Is there anything else that we should know about the dog?Please tell us anything that would either help us to place in the right home or reduce risk to other people and animalsIf your dog is not neutered or vaccinated, would you be prepared to get these done or donate towards themYesNoNot applicablePlease upload a photo of your dogChoose FileNo file chosenDelete uploaded fileBy signing and submitting this form, you confirm that all information provided is truthful and complete, and that you have not withheld any details that could endanger any person or animalStart signing your signature hereYour browser does not support e-Signature field.Send Message
