Want more information on how we can help find your dog a wonderful new home? Get in touch with us today! Rehome My Dog Private Nation-wide Dog Rehoming Services Toll Free: +1 (800) 518-1442 Email: Support@RehomeMyDog.net ORDER DOG REHOMING SERVICES Please carefully complete this form, providing us with as much detail as possible about your dog or puppy.nnOnce you submit this form, you will be taken to our Paypal Payments page to provide payment.nnIf you encounter any problems with this form, or have questions, please be sure to contact us by phone or email. Dog Rehoming Services Package*Please select the package you require from the selections below:Basic Dog Rehoming Package 39.95Basic Plus Dog Rehoming Package: 139.95Complete Dog Rehoming Package: 239.95Step 1: Please tell us about you. This information will be kept confidential, and is needed so that our rehoming team can contact you.Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Land Line:Cell Phone with Texting Capability:Email Facebook Profile Step 2: Please tell us about your dog or puppy. Please provide as much detail as possible so that we can develop an engaging and effective adoption story.Name of Dog:*Breed of Dog:*If known. If your dog is a mix of two or more breeds, please place the second breed in the next field. If y.ou do not know the breed at all, please put Mixed Breed.Breed of Dog: If your dog is a mix, the second known breed goes here.Boy or Girl?* Male Female Age of Dog:*Coloring:*Coat Length:*Has your dog been spayed or neutered?*Has your dog been micro-chipped?*Is your dog up-to-date on vaccinations?*Is your dog house trained?*Is your dog crate trained?*Is your dog leash trained?*Is your dog obedience trained?*Does your dog have any health problems?* Yes No If yes, please describe your dogs health problems in the area below:Does your dog have any behavior problems?* Yes No If yes, please describe your dogs behavior problems in the area below:Is your dog good with children?* Yes No More detail regarding children:Feel free to add more information on your dog's behavior with children here.Is your dog good with other dogs?* Yes No More detail regarding other dogs:Feel free to add more information on your dog's behavior with other dogs here.Is your dog good with cats?* Yes No More detail regarding cats:Feel free to add more information on your dog's behavior with other dogs here.Tell us about your dogs' history:*Here you can tell us how you obtained your dog (ie as a puppy from a breeder, a shelter or rescue. This information helps us tell your dog's story in a compelling way, so include as much information as you feel is relevant.Tell us about your dogs' personality:*Why are you needing to rehome your dog?*If you could choose the perfect home for your dog, what would it be like?*Are you willing to consider applications from outside of your immediate area?*YesNoUnsureIf yes, what distance from your location are you willing to go:Supplies and Equipment*Please list any supplies or equipment that you would like to include with your dog to the new home: Step 3: Pictures Now, let's provide a few photos with your information. Please add up to 3 photos below. You will be able to provide additional images by email once your information form is submitted.Photo 1Picture 2Picture 3PLEASE ANSWER THE FOLLOWING QUESTION:*What is 2 + 2 + 6 = ?Please enter a value between 9 and 11.