Current Intro Owner Details General Information Medical Information Behavioral Information Acknowledgement Complete Intro In order to be deemed suitable for our rehoming program all animals must meet minimal behaviour and medical criteria before rehomed. Our team members will need to spend some time with you asking questions about our pet so we can best determine any rehoming options. Should for some reason your pet not pass these assessments then BARC may seek alternative options with regards to rehoming through other welfare organisations. If your pet is deemed not suitable for rehoming, euthanasia may be considered. Please fill out this form to the best of your ability. Your answers will help us to get to know the animal and give us important background information to allow us to place the animal in a new home that is most suited to their individual needs. If your animal has current Council registration surrendering your pet to us is free of charge. Should your animal not be registered with Council, a payment to contribute to the cost of managing your pet may be requested but it not compulsory. Owner Details name: First name Last name Contact phone number Email address: Address (where the pet lives) General Information Pet name Pet type Dog Cat Breed Age Pet gender Male Female Desexed? Yes No Microchipped? Yes No Length of ownership? Where did you get your pet from? Do they spend time inside? Yes No Are they housetrained? Yes No Do they sleep inside? Yes No Do they use a dog-door? Yes No What does their diet mainly consist of? Pet mince Tinned food Meat rolls Bones Raw diet Dry biscuits Please name any specific brands of food Do they have any specialty dietary needs? Reasons for surrender Medical Information Name of regular vet clinic? Name that the vet records are under? Last known vaccination? Any known medical issues? Yes No Please list the medical issues Medical issues Please list the medical issues Behavioral Information How would you describe their behaviour in general? Talkative Friendly with family Friendly with visitors Shy with visitors Lived with children Lived with dogs/cats Affectionate Couch potato Very active Playful / highly energetic / sedate Confident / dominant / submissive Chases small / other animals Destructive Has had professional training Has a history of fence jumping / escaping Has a habit of digging / barking / chewing / aggression Describe the above behavioral options How do they respond to other dogs? Interacts / Friendly Shy / Nervous Dominant Aggressive N/A How do they respond to other cats? Interacts / Friendly Shy / Nervous Dominant Aggressive N/A How do they respond to other animals? Interacts / Friendly Shy / Nervous Dominant Aggressive N/A List the other animals Please tick the appropriate options in regard to your dog's behaviour? Walks well on a lead Pulls and strains on a lead Walks past/interats well with other dogs on a lead Is highly reactive when on a lead Has good recall when off a lead Attends off lead dog parks without issues Does your cat display any of the following behaviours? Scratching furniture/other things Chewing Plants Chewing Cords Spraying Escaping Inappropriate toileting Fighting with cats Predatory behaviour Aggression Does this cat use a litter tray? Yes No Sometimes If sometimes, how often do accidents occur How many litter trays does the cat have access to Preferred type of cat litter? Clumping Recycled Clay Sand-like Other… Enter other… Has the dog been involved in any incident or council investigation relating to the Domestic Animals Act? Yes No Describe the incident or council investigation Select what type of household environment you think would be suitable? Family with young children Family with teenagers Single person or adult family Older person/s Select what type of animal environment you think would be suitable? Cats Dogs Other small pets Only Pet Livestock Select what type of property environment you think would be suitable? Small house yard Large house yard Semi-rural property Rural / Farm property Any additional comment regarding the ideal home for them? Please tell us a little more about their personality, and anything else that you would like future adopter's to know Acknowledgement By surrendering your pet to us you are agreeing to transfer ownership of your pet to BARC, and your pet will be managed in accordance with the Domestic Animals Act (1994). Privacy statement Bendigo Animal Relief Centre Privacy Policy Surrendering on behalf of someone If you are surrendering the pet on behalf of someone else, please also download and complete the Surrender Consent form. Surrender Consent form To surrender your pet you'll need an appointment with BARC I have an existing appointment booked to surrender my pet I will contact BARC to discuss surrendering my pet I would like BARC to contact me to discuss surrendering my pet Date of existing booking Information message Please contact us on (03) 5441 2209 or [email protected] Information message BARC will contact you on the information provided to discuss within 2-5 business days. If the matter is urgent please call BARC on (03) 5441 2209 or the City of Greater Bendigo on 1300 002 642 Signature Sign above I agree that the information I have provided is correct I agree to the above I provide consent for the information contained in this form to be provided to a recognised pet rehoming organisation who has partnered with BARC for the purpose of assisting to rehome the pet listed on this form I consent to the above
