Delaware Valley Bichon Rescue

Rehoming Request



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	Delaware Valley Bichon Rescue P.O. Box 2411 Cinnaminson, NJ 08077 phone: 856-829-7615 fax: 775-637-4324 susandare@comcast.net

Delaware Valley Bichon Rescue works with families to help find new homes for their dogs when the families have extenuating circumstances that prevent them from being able to care for their canine friends. Please fill out this entire application to the best of your knowledge.

Our "Transfership of Ownership" form will need to be completed, signed, and turned over at time of surrender. If you'd like to review this form, please click here.

DVBR would like to reassure families who need to place their dogs in rescue that we have a rigorous screening process. Each potential family must first complete a comprehensive application. After we scrutinize each application, we contact the family's current or previous vet for a reference, and then we do a home inspection. Each dog's individual personality is considered when we look for a specific home. We will work hard to find the BEST possible home for every bichon that finds his/her way to our doors. Families who need to relinquish their pet/s to rescue are welcome to call or email us for additional information.

Contact & Personal Information

First Name:		Last Name:
Address:		City:
State:		Zip:
Daytime Phone:		Evening Phone:
Email:		Confirm Email:

General Dog Information

Bichon's Name:		Sex:
Age:		Neutered/ Spayed?
Approximate Weight:

Medical History & Vet Care Information

Please indicate if your dog is current (up-to-date) on the following:
	Rabies: Date of last shot: Distemper (DHLPP): Date of last shot: Bordetella (Kennel Cough): Date of last shot: Heartworm Test Date of last test: Results:
Can you provide proof of this vet care?
Can you provide heartworm medication?
Describe Bichon's overall health including any previous illnesses we should be aware of such as heartworm, luxating patella, cataracts, bladder stones, condition of teeth, etc.):
Describe the condition's of the Bichon's teeth:
Describe Bichon's overall appearance (condition of coat, etc.):

Veterinarian Information
Vet's Name:
Address:
Phone:		Fax:
Do you give your permission for the vet to release this dog's medical records?

Behavior & Temperament

Has this dog ever lived with (or been exposed to) other dogs?		Comments: (Please indicate his/her interactions here)
Has this dog ever lived with (or been exposed to)cats?		Comments: (Please indicate his/her interactions here)
Has this dog ever lived with (or been exposed to) children?		Comments: (Please indicate his/her interactions here and include ages of the children)
Is this dog housebroken?		Comments:
Good with strangers?		Comments:
Have any specific fears?		Comments:
Any bad habits?		Comments:
Has this Bichon ever bitten anyone?		If yes, who and under what circumstance:
Describe the general behavior/ temperament of this dog: (check all that apply)	Friendly Outgoing Playful Couch Potato Aggressive Energetic Shy Fearful Other
	If Other, please describe:

Rehoming Information

Why is this dog being placed in rescue?		How urgent is this placement?
How long have you had the bichon?
Is this bichon living with you at this time?		Do you certify that you are the owner of this bichon, and have the authority to place him/her in rescue?

contact information If the Bichon is not currently living with you

First name:		Last Name:
Address:		City:
State:		Zip:
Daytime Phone:		Evening Phone:

Additional Information

Can you provide food and/or equipment such as crates, bedding, dog toys, etc. to help make the dog's transition into rescue easier?		If yes, please provide details here:

Please let us know any other information you wish us to know in order to help with placing your dog.


By pressing the SUBMIT button, you attest that all of the information you have provided in this application is true and correct. Please do not hit the SUBMIT button more than once. You will receive a confirmation page when your application has been processed. A volunteer will contact you as soon as possible to make arrangements for your dog. You should hear from one of our volunteers within 24 to 48 hours. If you have any problems submitting this form please email us and make sure you describe what happened. You can also print out your application and mail it to: Delaware Valley Bichon Rescue, P.O. Box 2411, Cinnaminson, NJ 08077.

		Delaware Valley Bichon Rescue is a non-profit organization as recognized by the Internal Revenue Service pursuant to Section 501(c)3, et seq. of the Internal Revenue Code. All donations are 100% tax-deductible.

Many thanks to Patty Burke for allowing us to use her Bichon image in our logo. This image is copyrighted
and may NOT be copied from this website without the written permission of Patty Burke.