Dog Rehoming Request

Your Name *

Contact Number *

Email Address *

Are you the owner of the dog? *

Yes

No

If no, name of owner

Urgency of the rescue *

High risk situation for the dog

Dog is still being cared for

Where is the dog now? *

Select an option Shelter Private Residence Dog Rescue Organisation

Location/Address of Dog *

State *

Select an option ACT NSW NT QLD SA TAS VIC WA

Dog's Name *

Gender *

Male

Female

Male Desexed

Female Desexed

Date of Birth (if known)

If date of birth unknown, the estimated age of the dog

Microchip # (if known)

Why does the dog need a new home?

Has this dog displayed significant negative reactions to any of the following?

Cats

Chickens

Birds

Dogs

People or Children

Other

Health, vaccinations and any medical conditions

Please provide any details known about the dog(s)

Photos of the dog (up to 6)

Consent *

MRRA may contact me about this dog and, if it joins the rescue programme, show its photos and a description on the website - never my name, contact details or address

To show you are a person, what is 6 plus 1?

Submit rehoming request