North East Rottweiler Rescue & Referral

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Owner Surrender Application

We accept owner surrenders only from RI, CT, MA, NH, VT, and southern ME.

If you live outside this area and send us an application to surrender your dog, we will not respond.

Please click HERE for a list of rescues in your area.

Please complete this application in full. Incomplete applications will not be processed. NERR&R is under no obligation to accept any Rottweiler into its care.

Current Owner Information

Your Name (first and last):

Address:

City: ZIP:

Phone: Email:

Rottweiler Identifying Information

Name: AKC Registration:

Name and contact information for your Rottweiler's Breeder:

Have you contacted the breeder or shelter that you originally got your dog from?
Yes No

Why do you need to rehome your Rottweiler?:

What is your time limit in finding a new home for your Rottweiler?:

Date of Birth:

Sex: Male Female

Spayed or Neutered? Yes No

Tail Docked? Yes No

Tattooed or Microchipped? Yes No
Tattoo or Microchip Number:

Rottweiler Health Profile: (medical records must be provided before surrender)

Rottweiler's Veterinarian and contact information:

Name of client your dog is listed under at veterinarian:

Is your Rottweiler currently vaccinated? Yes No

Date of last veterinary appointment:

Date of last heartworm test:

Which brand of heartworm preventative is your Rottweiler currently taking?

Date of the last dose:

Date of last Lyme Disease test:

Is your Rottweiler vaccinated against Lyme Disease? Yes No

List any major medical conditions or surgeries your Rottweiler has ever had:

Rottweiler Personality Profile: (please be as detailed as possible)

Has your Rottweiler bitten, nipped or snapped at a person? Yes No

Does your Rottweiler bark or growl aggressively at people or other animals? Yes No

Is your dog shy or afraid of anything? Yes No

Describe your Rottweiler's temperament?

Has your dog lived with children? Yes No
Ages?

Is your dog good with children?

Has your dog lived with other animals? Yes No
What kind?

Is your dog good with cats and small animals? Yes No

Is your dog good with other dogs? Yes No

Has your dog ever fought with another dog or animal? Yes No

Is your Rottweiler crate trained? Yes No

Is your Rottweiler housebroken? Yes No

Where does your dog stay when left alone?

Does your dog have any destructive habits?

Does your dog like car rides? Yes No
What are some activities your Rottweiler likes?

What are some activities your Rottweiler dislikes?

Has your Rottweiler had any formal training? Yes No

Has your dog ever been protection trained? Yes No

Can you disturb your dog when he is eating? Yes No

Can you disturb your dog when he is sleeping? Yes No

Can you disturb your dog when he is playing with toys? Yes No

Does your dog guard any persons or objects? Yes No

Describe your Rottweiler's activity level:
Very High High Medium Low Very Low

What brand of food and what quantity does your dog eat?

What type of home would you feel would best suit your Rottweiler?

Character References: (please provide complete contact information for three different people who are personally familiar with your Rottweiler's character)

Reference 1:

Reference 2:

Reference 3:

Additional Comments:

Please check both boxes below. If either of the boxes are left unchecked, your application will NOT be processed.

By checking this box, I certify that the information provided on this form is true and correct. I understand that by providing this information, I am under no obligation to relinquish my Rottweiler to NERR&R nor is NERR&R under any obligation to accept my Rottweiler.

By checking this box, I am indicating that this is a valid and legal substitution for my written signature on this legal document titled "North East Rottweiler Rescue Owner Surrender Application".