Application for Surrender
Recycled Rotts, Inc.

Before you Continue

Please remember that Recycled Rotts cannot accept owner surrender rottweilers from all over the country. We concentrate on saving the rottweilers that need our help in the Chicago area, and they are in abundance so we are never without rottweilers to save. Even when you are in the Chicago area, Recycled Rotts gives priority to rotties that are presently in animal controls and shelters. Owner give ups are accepted only when space is available. You are welcome to fill out the surrender form and if we are unable to help, will pass on 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 the
to find a rescue organization near to your location and call them yourselves (cannot guarantee that all rescue organizations are in the network online). Also, it is recommended that you help yourself in looking for a loving home for your rottweiler. Visit the above site first if you can, and then come back and fill out the form below.

If you have found a rottie with a Recycled Rott tag or otherwise identified as a Recycled Rott please contact us immediately. For other stray rotties, please call your local animal control or shelter. Recycled RottsSM is not authorized to pick up strays, nor do we have the facilities to house them.

NOTE: If the rottweiler you wish to surrender was placed in your home by us, Recycled Rotts Inc., it is NOT necessary to fill this form out. Just call/email us and leave a message:  Recycled Rotts Contact Page or (630) 551-0729
It is written in your contract at the time of placement that we take our rottweilers back in the event you wish to surrender them.

Personal Information


Name:
City: State:
E-Mail address:
Phone:

Where is the dog located:
In a Shelter.
At an Animal Control facility.
Rescued by ME personally and is staying with ME.
I own the dog and it is still with me at this time.
Other: (specify)
How long has the dog been in your or the shelter/AC's custody?
If you own the dog, please tell us why you must surrender it. Please explain in detail.


IF you are representing a Shelter or Animal Control Organization please give the following:
Organization Name:
Phone if other than above:
Contact Person if other than yourself:


About the DOG


(if you have more than one dog to surrender, than fill out one application for each dog, making sure your name and email address are on each application. If you are from animal control or a shelter with several animals, just fill out the "Other Comments" for each section below to describe the dogs. If we have any futher questions, we will contact you by phone or by email)

Information about the Dog:
Name of the dog:     
Sex of the dog:      Male           Female

Age of the dog:
Date of Birth if known  
Age is unknown, but approximately


Type of the dog:      Purebred Rottweiler              Mix
If the dog is a mix, name other breed(s) mixed with: (best guess is ok)
Does the dog have a tail? YES            NO
Other Comments:


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

Dog General History:

Where did you originally get/purchase/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
Have you contacted the breeder?YES         NO
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      OR     an Outside Dog
Other Comments:


Medical History:

If you are the present owner of this dog, please provide information about the dog's veterinarian:
Veterinarian's Name:  
   and Phone Number:
Has this dog been neutered or spayed? YES            NO
Has the dog been tested for heartworm? YES            NO
if yes, test was: positive    negative
Is the dog currently on heartworm preventative medication? YES         NO
If not, when was the last date that heartworm preventative was given?  
Is this dog current with it's vaccinations? YES         NO
Please provide other details of known/suspected medical conditions of this dog.

Other Comments:



Behavior:

Is the dog housebroken?   YES       NO
This dog:    needs to be confined to his/her crate.  Explain
        confined to a certain area of the house.  Explain
        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
Is the dog good and well socialized around (check all that apply but do not check if unknown):
   Other Male Dogs         Other Female Dogs
   Small Dogs         Cats          Other Small Animals
Do you feel the dog is overly possessive about his food/treats/toys?   YES          NO
Please tell us about other behavior issues this dog may have.


Other Comments:



Obedience:

Does the dog have knowledge of basic commands? (check those that apply)
   SIT           STAY           COME          DOWN
When on a leash, do you walk the dog?   or   does the dog walk you?
Has the dog had formal obedience training? Please explain.


Other Comments:




How did you hear about Recycled Rotts, Inc.?

We reserve the right to refuse acceptance of any rottweiler. Acceptance is based on many criteria, one of which is space availability. If you are out of our area, we will pass on your surrender form to another rescue. I understand that the information contained in this form might be passed on to another rescue.    YES    OR    NO

Space for additional comments:

I certify that the information provided on this form is true & correct. I understand that an physical evaluation of the dog by an experienced rescue volunteer will be required before we accept surrender. If upon inspection we find that information contained in this surrender form to be false, we retain the right to turn down acceptance of the surrender at anytime during the evaluation.

 

Signature
Date

Recycled Rotts, Inc.SM
PO Box 1082
Oswego, IL 60543

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• All rights reserved • Updated 5/6/04