EARS Rehome Request Form

Today's Date *

First Name *

Last Name *

Street Address *

Zip Code *

City *

State *

Phone Number (Primary) *

Phone Number (Secondary) *

Email Address

Your Pet's Name *

Pet Species *

Breed *

Pet's Gender *

Age of Pet *

If known, date of birth

Weight of Pet *

Is the pet spayed (female) or neutered (male)? *

Has the Pet Been Tested for Heartworm? *

What was the Result of the Heartworm Test? *

Is the Pet Currently Receiving Heartworm Preventative? *

What Brand of Heartworm Preventative is the Pet Receiving?

What was the Date of the Last Dose?

Is the Pet Currently Receiving Flea/Tick Preventative? *

What Brand of Flea/Tick Preventative is the Pet Receiving?

What was the Date of the Last Dose?

Has the Pet Received an Annual Rabies Vaccine? *

On What Date was the Rabies Vaccine Given?

What Other Vaccine(s) Has the Pet Received?

Is the Pet Microchipped? *

What Brand is the Microchip (if known)?

What is the Microchip Number (if known)?

Does the Pet Have Any Allergies or Medical Conditions That We Need To Know About? *

Veterinarian Name *

Veterinarian Address, City, State, Zip *

Veterinarian Phone Number *

Date of Last Vet Visit

Reason for the Vet Visit

What Brand of Food is the Pet Currently Eating? *

How Much Food and How Often Is the Pet Fed? *

Is Your Pet House (dog) or Litter (cat) Trained? *

Please Tell Us Some of the Distinctive Behaviors of Your Pet That We Should Know About? Good and Challenging. *

Does Your Pet Get Along With Cats? *

Does Your Pet Get Along With Dogs? *

Does Your Pet Get Along With Children? *

Does Your Pet Have Any Aggression Around His/Her Food Dish? *

How Is Your Pet's When Getting Treats? *

Please Explain Any Commands or Signals That Your Pet Understands. *

Where Does Your Pet Sleep? *

Why Are You Asking EARS to Re-home Your Pet? *

Is There Any Other Information About Your Pet That You'd Like To Share? *

Please Upload a Picture of Your Pet. If Unable to Upload, Please Email To ears2urescue@gmail.com. This Is A Requirement. *

Please Upload A Copy Of Your Pet's Vet Record. If Unable to Upload, Please Email To ears2urescue@gmail.com. This Is A Requirement. *

To my knowledge, the pet has not shown any signs of aggression or been vicious to humans or animals. Please initial. *

For Foster To Re-home Only. I have agreed to assign this pet to EARS and that I will foster and care for this pet until such time when EARS has found a new home for my pet. Please initial. *