Surrender Form | Pointer Rescue Service

Name of dog(Required)

Sex(Required)

Colour(Required)

Microchip number

Microchip form signed?(Required)

Inoculation record?(Required)

Neutered / Spayed?(Required)

Date of neutering or last season(Required)

Date last wormed(Required)

Date of last flea treatment(Required)

Any medical conditions?

Medications supplied

Reason(s) for surrender

I am the owner of or have the authority to surrender to Pointer Rescue Service the animal described above. I hereby relinquish all rights of ownership. I also authorise the release of any veterinary records regarding the animal.

I certify that to the best of my knowledge I have disclosed all information about the animal concerning health, behaviour, history and anything else that may affect the safe placement of the animal in a new home and that all statements made above are true and correct. Failure to disclose accurate information will cause issues; due to the dangerous dogs act and the requirements of charities working with dogs not to pass on dangerous dogs, a dog when professionally assessed by a registered vet and deemed as dangerous will be put to sleep with no recourse to you.

Your name(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 Town / City County Postal Code Country

Signature(Required)

Date(Required)

Rehoming with Heart

We understand that surrendering a beloved dog is never easy. If you're facing a difficult change in circumstances, we're here to help with compassion and care.

Our dedicated volunteers work hard to find loving new homes for dogs in need. To support this process, we kindly ask for a £150 donation when rehoming a dog.

Please call or email us if you are unable to make this donation so that we can provide you with an alternative option—we’re here to listen and support you every step of the way. Thank you for trusting us.

Surrender Amount

Total to pay today

Credit Card(Required)