Rehoming Request

Contact & Personal Information

First Name *

Last Name *

Email address *

Phone Number *

Street Address *

City *

State *

Zip Code *

General Dog Information

Name *

Breed *

Gender *

Age *

Approximate Weight *

Medical History & Vet Care Information

Please indicate if your dog is current (up-to-date) on the following:

Rabies *

Yes

No

Don't Know

Date of Last Rabies Shot

Distemper (DHLPP) *

Yes

No

Don't Know

Date of Last Distemper (DHLPP) Shot

Bordetella (Kennel Cough) Shot *

Yes

No

Don't Know

Date of Last Bordetella Shot

Heartworm Test *

Yes

No

Date of Last Heartworm Test

Heartworm Test Results

Describe the dogs overall health including any previous illnesses we should be aware of. *

Can you provide proof of this vet care? *

Yes

No

Veterinarian Information

Vet's Name

Address

Phone Number

Fax Number

Do you give your permission for the vet to release this dog's medical records?

Yes

No

Behavior & Temperament

Is this dog housebroken *

Yes

No

Don't Know

Comments

Any bad habits? *

Yes

No

Please describe the bad habits.

Has this dog ever bitten anybody? *

Yes

No

Who and under what circumstance?

Photos

Please upload UP TO 5 photos of your dog. A photo will help facilitate the acceptance and placement of your dog!

Drag and drop files here or Browse

Rehoming Information

Why is this dog being placed in a rescue? *

How urgent is this placement? *

How long have you had this dog? *

Do you certify that you are the owner of this dog and have the authority to release him/her to Lil' Paws Maltese Rescue? *

Yes

No

Please let us know any other information you wish for us to know in order to help with placing your dog. Remember, the more information, the better.

Rehoming Request

Please be sure to thoroughly fill out the application.
Incomplete applications may be automatically rejected.

Contact & Personal Information

General Dog Information

Medical History & Vet Care Information

Please indicate if your dog is current (up-to-date) on the following:

Veterinarian Information

Behavior & Temperament

Photos

Rehoming Information

By pressing the SUBMIT button below, you attest that all of the information you have provided in this application is true and correct.

Lil' Paws saves lives and builds families. Stay in touch with us by subscribing to our newsletter.

Rehoming Request

Please be sure to thoroughly fill out the application.Incomplete applications may be automatically rejected.

Contact & Personal Information

General Dog Information

Medical History & Vet Care Information

Please indicate if your dog is current (up-to-date) on the following:

Veterinarian Information

Behavior & Temperament

Photos

Rehoming Information

By pressing the SUBMIT button below, you attest that all of the information you have provided in this application is true and correct.

Lil' Paws saves lives and builds families. Stay in touch with us by subscribing to our newsletter.

Please be sure to thoroughly fill out the application.
Incomplete applications may be automatically rejected.