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Animal Surrender Form

Animal Surrender Form

Owner’s Details

First Name *

Surname *

Mobile phone number *

Address

Address

Address

Address

Suburb

Suburb

Local Council

Local Council

Post Code

Post Code

Email Address *

Animal’s Details

Pet’s Name *

Breed *

Sex

Male

Female

Desexed:

Y

N

Age / Date of Birth *

Microchip Number *

Reason for surrender *

Where did you get your pet from?

How long have you had your pet?

Does your pet live with other animals?

Is your pet registered with your local council? *

Yes

No

What is the registration / tag number?

When was your pet's last vet check *

When was your pet's last vaccination? *

Please provide your pet's vet history

Maximum file size: 262.14MB

How does your pet usually behave towards the following?

Familiar people & Older Children

Avoids

Soft Approach

Seeks Interaction

Pulls Towards

Barks

Growls

Tail Wagging

Unfamiliar People & Older Children

Avoids

Barks

Growls

Pulls Towards

Tail Wagging

Soft Approach

Seeks Interaction

Children under 8 years

Avoids

Barks

Growls

Pulls Towards

Tail Wagging

Seeks Interaction

Soft Approach

Familiar dogs

Avoids

Barks

Growls

Tail Wagging

Pulls Towards

Soft Approach

Seeks Interaction

Unfamiliar Dogs

Avoids

Barks

Growls

Tail Wagging

Pulls Towards

Seeks Interaction

Soft Approach

Cats

Avoids

Barks

Growls

Tail Wagging

Pulls Towards

Seeks Interaction

Soft Approach

Does your pet have any past or present medical conditions?

Yes

No

Details if yes

Is your pet currently (or should it be) on any medications?

Yes

No

If yes, what medication?

DOGS ONLY

Does your dog display any of the following behaviors? And describe:

Has your dog ever bitten another dog or human?

Yes

No

Please specify:

Has your dog ever been bitten by another dog?

Yes

No

Please specify:

Excessive barking?

Yes

No

Please specify:

Destructive behaviors (such as digging/barking)?

Yes

No

Please specify:

Escapes yard or enclosure?

Yes

No

Please specify:

When left home alone, what do they do?

Sleeps/ Lies Down

Barks/Howls

Is destructive

Toilets inside/inappropriately

CATS ONLY

Does your cat display any of the following behaviors? And describe:

Spraying (urine)?

Yes

No

please specify:

Defecating (faeces) in areas other than the litter tray?

Yes

No

please specify:

Destructive behaviors (clawing, chewing)?

Yes

No

please specify:

Please upload a photo of your pet (if this gives an error message please contact surrender@secondchanceanimalrescue.com.au *

Maximum file size: 262.14MB

Any other comments?

How long can you keep the animal? *

Are you in the position to assist with the veterinary or administrative costs to prepare your animal for adoption? *

Surrender Declaration

Declaration *

I am the owner of the above mentioned animal and declare that no other person has any property interest therein.

I confirm that this animal has not been declared dangerous and there are no outstanding fines, complaints or local council orders with regard to this animal.

By signing below, I certify that the information I have provided is accurate and truthful to the best of my knowledge.

I understand that if Second Chance Animal Rescue can take my animal in a surrender fee will be involved, this amount will be discussed at the time of the surrender appointment.

Is the animal microchipped in your name?

Yes

No

Declaration *

This animal is microchipped and I understand that should Second Chance Animal Rescue be able to take my animal that I give permission to change the microchip ownership details into THEIR name or any NEW OWNERS name as they see fit. I understand that SCAR will be charged and will pay for the change of ownership fee charged by the microchip registry.

If you are human, leave this field blank.

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