Re-homing application

Your Full name

Mobile number

Landline number

Full address

Post code

Do you have any mental issues?

If Yes please give details

Dog/s name/s

Breed

Age

Colour

How long have you had this dog?

Reason for giving up this dog?

Is this dog good with with kids?

Has it lived with a cat?

Please describe its temperament

Has it got any behavioral issues?

If yes please describe

How often do you walk it?

Do you ever walk it in the town/city center?

Is it nervous in any way?

If yes please explain

Do you work?

Does it bark when left?

How long can it be left for?

Is it ever left all day?

What's it like on lead?

What's it like off lead?

Is it fully house trained?

Is it vaccinated?

Is it micro chipped?

Has this dog got paperwork?

If yes what's the microchip no?

When was it last flea treated?

When was it last wormed?

When was it last bathed?

Is this dog spayed/castrated?

Has it any health issues?

If yes please give details

Has it ever had a major injury?

If yes please give details

Age group

Your work status

Can you afford a one off donation?

If yes how much can you donate?

Have you read our terms and conditions?

Yes

I agree that my dog now belongs to Leicestershire Dogs legally

I agree to Leicestershire Dog's terms and conditions