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Owner Details Name*
First
Last
Address Street Type*
StreetType Street Road Court Drive Place Avenue Crescent Alley Alleyway Amble Approach Arcade Basin Bay Bayoo Beach Bend Block Bluff Bottom Boulevard Brace Brae Branch Break Briars Bridge Broadway Brow Bypass Byway Causeway Central Centre Centreway Chase Circle Circuit Circus Cliff Close Club Common Concourse Connector Copse Corner Corso Courtyard Cove Creek Crest Cross Crossing Crossroad Crossway Cul-de-sac Cutoff Dale Deviation Dip Distributor Down Driveway Easement Edge Elbow End Entrance Esplanade Estate Estates Expressway Extension Fairway Fire track Firetrail Flat Follow Foreshore Formation Freeway Front Frontage Gade Gap Garden Gardens Gate Glade Glen Grange Green Ground Grove Gully Hall Haven Heights Highroad Highway Hill Hills Hollow Interchange Intersection Island Isle Junction Key Lake Lakes Landing Lane Laneway Lawn Line Link Little Loaf Lookout Loop Lower Main Mall Manor Mead Meadow Meadows Meander Mews Mills Millway Motorway Mount Nook Outlook Parade Park Parklands Parkway Pass Passage Path Pathway Piazza Pike Pine Pines Plateau Plaza Pocket Point Port Promenade Pursuit Quad Quadrangle Quadrant Quay Quays Ramble Range Rapids Reach Reserve Rest Retreat Ride Ridge Ridgeway Right of way Rise River Riverway Riviera Roads Roadside Roadway Ronde Rosebowl Rotary Round Route Row Rue Run Service way Shore Shores Sideroad Siding Slope Sound Spring Springs Spur Square State highway Strait
Address Suburb*
State Queensland New South Wales South Australia Australian Capital Territory Western Australia Victoria Northern Territory Tasmania
City
Postcode
Is your mailing address same as your physical address?* Mailing Address Street Type*
StreetType Street Road Court Drive Place Avenue Crescent Alley Alleyway Amble Approach Arcade Basin Bay Bayoo Beach Bend Block Bluff Bottom Boulevard Brace Brae Branch Break Briars Bridge Broadway Brow Bypass Byway Causeway Central Centre Centreway Chase Circle Circuit Circus Cliff Close Club Common Concourse Connector Copse Corner Corso Courtyard Cove Creek Crest Cross Crossing Crossroad Crossway Cul-de-sac Cutoff Dale Deviation Dip Distributor Down Driveway Easement Edge Elbow End Entrance Esplanade Estate Estates Expressway Extension Fairway Fire track Firetrail Flat Follow Foreshore Formation Freeway Front Frontage Gade Gap Garden Gardens Gate Glade Glen Grange Green Ground Grove Gully Hall Haven Heights Highroad Highway Hill Hills Hollow Interchange Intersection Island Isle Junction Key Lake Lakes Landing Lane Laneway Lawn Line Link Little Loaf Lookout Loop Lower Main Mall Manor Mead Meadow Meadows Meander Mews Mills Millway Motorway Mount Nook Outlook Parade Park Parklands Parkway Pass Passage Path Pathway Piazza Pike Pine Pines Plateau Plaza Pocket Point Port Promenade Pursuit Quad Quadrangle Quadrant Quay Quays Ramble Range Rapids Reach Reserve Rest Retreat Ride Ridge Ridgeway Right of way Rise River Riverway Riviera Roads Roadside Roadway Ronde Rosebowl Rotary Round Route Row Rue Run Service way Shore Shores Sideroad Siding Slope Sound Spring Springs Spur Square State highway Strait
Mailing Address Suburb*
State Queensland New South Wales South Australia Australian Capital Territory Western Australia Victoria Northern Territory Tasmania
City
Postcode
Are you over the age of 18 years? (ID is required at time of surrender)* Please note: If no, a parent/guardian must complete the form and be present at the time of surrender.
Your Pet Details What type of pet(s) do you need to surrender? Please note: we do not accept surrenders of mice or reptiles.
Please provide the number of animals to surrender. Is this a litter of puppies/kittens from your own mother cat/dog? Choose below Yes No
If yes, would you be interested in our Last Litter Program which offers free desexed of your mother cat/dog? Choose Below Yes Third Choice
Size of pet Small (0-10kg) Medium (10-25kg) Large (25+kg)
Size of additional pet Small (0-10kg) Medium (10-25kg) Large (25+kg)
Age of your pet - Please select - 0-6 months 6-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+
Please note: If you are surrendering a dog that was born after 26th of May 2017, by law you must have a valid supply number upon surrendering the animal. You can apply for your supply number here https://qdbr.daf.qld.gov.au/
NOTE: Please note individual ages of your pets.
Age of your additional pet - Please select - 0-6 months 6-12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+
Please note: If you are surrendering a dog that was born after 26th of May 2017, by law you must have a valid supply number upon surrendering the animal. You can apply for your supply number here https://qdbr.daf.qld.gov.au/. NOTE: Please note individual ages of your pets.
Gender of your pet - Please select - Entire female Desexed female Entire male Desexed male Unknown
Gender of your additonal pet - Please select - Entire female Desexed female Entire male Desexed male Unknown
What is the breed of your dog/puppy? List of breeds Alaskan Malature American Bulldog American Staffy Australian Cattledog Australian Kelpie Australian Silky Terrier Australian Terrier Beagle Bichon Frise Border Collie Boxer Bull Arab Bull Terrier Bullmastiff Cavalier King Charles Spaniel Chihuahua Cocker Spaniel Dachshund Fox Terrier German Shepherd Golden Retriever Great Dane Greyhound Irish Wolfhound Jack Russell Terrier Jack Russell Terrier, Wire-Hair Labrador Labrador Retriever Lhasa Apso Maltese Maremma Sheepdog Mastiff Mini Foxie Cross Mini Foxy Neapolitan Mastiff Pomeranian Poodle Miniature Poodle Toy Pug Rhodesian Ridgeback Rottweiler Sharpei Shepherd Shih Tzu Siberian Husky Silky Terrier Smithfield Cattle Dog Staffordshire Bull Terrier Terrier Other
What is the breed of your additional dog/puppy? List of breeds Alaskan Malature American Bulldog American Staffy Australian Cattledog Australian Kelpie Australian Silky Terrier Australian Terrier Beagle Bichon Frise Border Collie Boxer Bull Arab Bull Terrier Bullmastiff Cavalier King Charles Spaniel Chihuahua Cocker Spaniel Dachshund Fox Terrier German Shepherd Golden Retriever Great Dane Greyhound Irish Wolfhound Jack Russell Terrier Jack Russell Terrier, Wire-Hair Labrador Labrador Retriever Lhasa Apso Maltese Maremma Sheepdog Mastiff Mini Foxie Cross Mini Foxy Neapolitan Mastiff Pomeranian Poodle Miniature Poodle Toy Pug Rhodesian Ridgeback Rottweiler Sharpei Shepherd Shih Tzu Siberian Husky Silky Terrier Smithfield Cattle Dog Staffordshire Bull Terrier Terrier Other
What is the breed of your cat/kitten? List of breeds Domestic Short Hair Domestic Medium Hair Domestic Long Hair Bengal British Shorthair Burmese Devon Rex Himalayan Maine Coon Manx Persian Ragdoll Russian Blue Scottish Fold Siamese Snowshoe Sphynx Tonkinese Other
What is the breed of your additional cat/kitten? List of breeds Domestic Short Hair Domestic Medium Hair Domestic Long Hair Bengal British Shorthair Burmese Devon Rex Himalayan Maine Coon Manx Persian Ragdoll Russian Blue Scottish Fold Siamese Snowshoe Sphynx Tonkinese Other
Is your pet/s vaccinated?* - Please select - Yes No Unknown
Is your pet/s up to date with flea, tick and worming treatments?* - Please select - Yes No Unknown
Is your pet/s microchipped? - Please select - Yes No Unknown
Brief description of why you need to surrender your pet/s*
Is there anything that would help you keep your pet?
Home Information Where did you get your pet from? - Please select - Found AWLQ Breeder Facebook/Social Media Gift From Friend/Relative Gumtree Newspaper Giveaway Other Shelter or Rescue Group Own Litter Pet Shop Other
Does your pet live inside, outside or both? - Please select - Inside Outside Inside & Outside
How much time does your pet spend alone? - Please select - Less than 4 hours Between 6-8 hours Between 8-12 hours More than 12 hours
Not including night time sleeping hours
When no one is home, where is your pet kept? - Please select - Inside Outside
Where does your pet sleep at night? - Please select - Inside Outside
Are there children who live in the home with your pet? - Please select - Yes No
If yes, how old are the children?
Sociability with children. Is your pet social with children in the home? - Please select - Yes No N/A
Note: If no, please explain in description box below
Has your pet ever bitten/been aggressive to a child in or outside of the home?* - Please select - Yes No
If yes, please describe the incident. If no, please give a brief description of how they interact.*
Note: If yes, please explain in detail.
Has your pet met children other than immediate family?* - Please select - Yes No
If yes, who have they met? Relatives/children's friends/children on walks or in parks? and how do they interact?*
Sociability with adults. Is your pet social with adults in the home? - Please select - Yes No
Note: If no, please explain in description box below.
Has your pet met adults other than immediate family?* - Please select - Yes No
How does your pet behave when visitors come to the house? - Please select - Barking Boisterous Excited Avoids Growls Fearful Calm Hiss Scratch Purr
How does your pet behave with people outside of your home? - Please select - Barking Boisterous Excited Avoids Growls Fearful Calm Hiss Scratch Purr
Has your pet bitten/been aggressive to an adult in the home?* - Please select - Yes No
Has your pet bitten/been aggressive to an adult outside of the home?* - Please select - Yes No
Sociability with pets in the home Are there any other pets in the home?* - Please select - Yes No
Which pet arrived in the home first? - Please select - Pet being surrendered Other pet
Is your pet comfortable with other pets and humans being around when they are eating? - Please select - Yes No N/A
If no, what do they do? Ignore/keep eating/stop eating/move away/growl? - Please select - Ignore Keep eating Stop eating Move away Growl
Has your pet ever been in a fight with any of the pets in the home? - Please select - Yes No N/A
Do you know who started the fight, what it was over and were there any injuries sustained?*
Sociability with animals outside the home Has your dog met other dogs?* - Please select - Yes No
If yes, how did they react?*
Has your dog met other cats?* - Please select - Yes No
If yes, how did they react?*
How does your dog react if they see another dog when out walking? - Please select - Bark Boisterous Excitable Calm Pulls towards them Avoids Continues walking Growls Fearful Lunges Aggressive Attempt to bite
Has your pet ever gotten into a fight or attacked another animal?* - Please select - Yes No
If yes, please describe incident and if there were any injuries sustained.*
Did your pet start the fight? - Please select - Yes No N/A
Behaviour information Does your pet have any problem behaviours? Digging/barking/chewing/scratching/destructive?* - Please select - Yes No
If yes, please describe what they do?*
Is there anything that may scare your pet or cause them to be fearful?* - Please select - Yes No
How often is your dog exercised? - Please select - Daily Weekly Occasionally Never Not applicable
Is your pet independent and likes to be left alone?* - Please select - Yes No
Has you dog had training or attended classes? - Please select - Yes No
Has your pet ever escaped your yard?* - Please select - Yes No N/A
If yes, how do they get out? - Please select - Jumps Digs Breaks out Walks out
What type of fencing do you have? - Please select - Wire Timber Colourbond None Other N/A
What is the height of your fence? 3ft/4ft/5ft/6ft/6ft+? - Please select - 3ft 4ft 5ft 6ft 6ft+ N/A
Is you dog currently or has dog ever been regulated by a council?* Please select Yes No
(Declared dangerous, menacing or restricted breed)
Health and Veterinary Information Does your pet currently have any medical or health conditions?* - Please select - Yes No
Has your pet previously had any medical or health conditions? - Please select - Yes No Unknown
If yes, please provide details:*
When did your pet last go to the vets?*
New home recommendations Can you describe your pet's personality in a few words?*
Note: if surrendering more than one animal, please provide details for each of them.
What sort of home/family do you think your pet would suit?*
Note: if surrendering more than one animal, please provide details for each of them.
Adding some of your favourite photos will help AWLQ to promote your pet for rehoming. Please note that this is optional. Photo 1
Adding some of your favourite photos will help AWLQ to promote your pet for rehoming. Please note that this is optional. Photo 2
Surrender Conditions Once AWLQ have received this form you will be placed on the waiting list. This timeframe varies depending on the amount of applications we are receiving and animals we are assisting from external pounds each week. An AWLQ staff member will contact you if they require any further information. You will be contacted to book a day and time to bring your pet to the rehoming centre. A booking must be made for all surrenders as this assists us in maintaining our promise to never euthanise a healthy, sociable and treatable animal in our care.
Please note that AWLQ request a surrender fee of $50 for individual animals and $80 for litters or groups of animals. AWLQ have a last litter fund program which offers owners who have surrendered a litter with a voucher to desex the mother for free. Please ask our staff for more information or contact our National Desexing Network program directly on info@ndn.org.au
By submitting this surrender application you agree to the above conditions* Hidden
Application stage Hidden
Booking time Hidden
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