EMERGENCY BOARDING READMISSION FORM Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 3Case Manager DetailsHospital/Agency Name *Hospital/Agency Contact Person & PositionHospital/Agency Phone Number *Hospital/Agency Email *Hospital/Agency PhonePet Owner’s DetailsFull Name *FirstLastPhone - Mobile *Email *Alternative/Emergency Contact Full Name *Their relation to pet ownerEmergency Contact Phone NumberNumber of animals to be cared forLocation of animalsClient HomeOtherLocation of animals *Time period requested (1 month max)Date support requiredDate of expected discharge/collectionWill a nominated person be collecting your pet? *YesNoIf yes, what is their name?Reason for emergency boarding assistance: *NextPet’s Details (one form to be completed for each pet)Name *DesexedYesNoMicrochipped?YesNoMicrochip No.Animal Medical HistoryAnimal's regular vet details (Name, number and address?)Last vaccination dateAny current illnesses or injuries?Currently on medicationYesNoIf yes, what type and dosage: (*All medication must be in original packaging with instruction/dosage label attached) (**Please send photos of medication along with this application form)Last flea & tick treatment date Last worm treatment dateAny previous illnesses or injuries?Behaviour HistoryHas your pet ever been declared dangerous by council?YesNoHave they shown aggression towards humans?YesNoHave they shown aggression towards other animals?YesNoHave they shown aggression (resource guarding) around food/toys/other humans?YesNoCare and WellbeingWhat do they normally eat? (incl. treats)What time(s) do they eat?Where do they normally sleep?Do they like to play?How many times a day do they have walks? (Dogs)What is your pet coming into our care with? (e.g. leash, collar, harness, bed etc.)Has anything changed with your pet since their last visit to the program (e.g eating habits, behaviours, injuries etc?NextTerms and conditions *I agree to the privacy policy1. This foster agreement is for a set period (refer to page 1 – Discharge date of animal). I understand and agree that I will have the opportunity to ask for an extension of care for my pet(s), but the AWLQ may not be able to accommodate my request. 2. The AWLQ will return my pet(s) only to me, unless I surrender them or designate a person to claim my pet(s) in my place, in which case I will notify the AWLQ at least 48 hours before. If I do designate a person to claim my pet(s) it shall be in writing and witnessed. I understand the AWLQ will not release my pet(s) to a person that has not been designated prior. 3. The AWLQ will provide the best care possible for my pet(s) during the sheltering period but notes that there are inherent risks and dangers when dealing with any animal, including but not limited to changes in the animals behaviour or weight, contraction of contagious disease, or loss or death of the pet(s). 4. I understand that my pet(s) may (or will) be fostered by the AWLQ on site or off site with a foster carer. Should the AWLQ choose to house my pet at an alternative location I will not hold any staff or volunteers liable for any illness, injury, or death of my pet(s). 5. I understand that AWLQ’s Emergency Boarding program is a confidential program and I will not divulge any information regarding the location of my pet(s) in this program to anyone not authorised. I understand should I disclose any such information to a non-authorised person this agreement is null and void and I will have 48 hours to reclaim my pet(s) from the AWLQ. 6. The AWLQ and/or its designated off-site foster care provider will provide daily food, water, socialisation, exercise and basic preventative care for my pet(s). 7. I understand that AWLQ reserves the right to seek veterinary care without my approval including administering treatments, medications and surgery. I acknowledge that should Veterinary care and attention for the animal be warranted, the AWLQ may provide only the minimum care the comfort and stabilise the animal. Should my pet(s) require extended veterinary care, I agree to reimburse the AWLQ for any veterinary attention or medication needed. However I understand that I will be informed prior to any such procedure. 8. Your pet will be health checked, vaccinated (if no record of vaccinations or vaccinations are outdated) and scanned for a microchip (the pet being microchipped and vaccinated is a compulsory requirement for admission to the program). 9. Should I fail to reclaim my pet by the designated time I understand and agree I will relinquish permanent ownership and custody of such animal to the AWLQ. 10. I consent to the Animal Welfare League QLD obtaining my animal(s) full medical vet history from the vet clinic disclosed under 'Animal Medical History', for Emergency Boarding purposes. ** The EB Co-Ordinator may sign this on the owner’s behalf if completed remotely and verbal permission is given by the owner. Please sign here to acknowledge T&C 8 of the AWLQ Emergency Boarding Admission Form:Name of owner of pet *Signature of owner * Clear Signature DateName of case worker/authorised person *Signature of case worker/authorised person * Clear Signature DatePreviousSubmit
Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 3Case Manager DetailsHospital/Agency Name *Hospital/Agency Contact Person & PositionHospital/Agency Phone Number *Hospital/Agency Email *Hospital/Agency PhonePet Owner’s DetailsFull Name *FirstLastPhone - Mobile *Email *Alternative/Emergency Contact Full Name *Their relation to pet ownerEmergency Contact Phone NumberNumber of animals to be cared forLocation of animalsClient HomeOtherLocation of animals *Time period requested (1 month max)Date support requiredDate of expected discharge/collectionWill a nominated person be collecting your pet? *YesNoIf yes, what is their name?Reason for emergency boarding assistance: *NextPet’s Details (one form to be completed for each pet)Name *DesexedYesNoMicrochipped?YesNoMicrochip No.Animal Medical HistoryAnimal's regular vet details (Name, number and address?)Last vaccination dateAny current illnesses or injuries?Currently on medicationYesNoIf yes, what type and dosage: (*All medication must be in original packaging with instruction/dosage label attached) (**Please send photos of medication along with this application form)Last flea & tick treatment date Last worm treatment dateAny previous illnesses or injuries?Behaviour HistoryHas your pet ever been declared dangerous by council?YesNoHave they shown aggression towards humans?YesNoHave they shown aggression towards other animals?YesNoHave they shown aggression (resource guarding) around food/toys/other humans?YesNoCare and WellbeingWhat do they normally eat? (incl. treats)What time(s) do they eat?Where do they normally sleep?Do they like to play?How many times a day do they have walks? (Dogs)What is your pet coming into our care with? (e.g. leash, collar, harness, bed etc.)Has anything changed with your pet since their last visit to the program (e.g eating habits, behaviours, injuries etc?NextTerms and conditions *I agree to the privacy policy1. This foster agreement is for a set period (refer to page 1 – Discharge date of animal). I understand and agree that I will have the opportunity to ask for an extension of care for my pet(s), but the AWLQ may not be able to accommodate my request. 2. The AWLQ will return my pet(s) only to me, unless I surrender them or designate a person to claim my pet(s) in my place, in which case I will notify the AWLQ at least 48 hours before. If I do designate a person to claim my pet(s) it shall be in writing and witnessed. I understand the AWLQ will not release my pet(s) to a person that has not been designated prior. 3. The AWLQ will provide the best care possible for my pet(s) during the sheltering period but notes that there are inherent risks and dangers when dealing with any animal, including but not limited to changes in the animals behaviour or weight, contraction of contagious disease, or loss or death of the pet(s). 4. I understand that my pet(s) may (or will) be fostered by the AWLQ on site or off site with a foster carer. Should the AWLQ choose to house my pet at an alternative location I will not hold any staff or volunteers liable for any illness, injury, or death of my pet(s). 5. I understand that AWLQ’s Emergency Boarding program is a confidential program and I will not divulge any information regarding the location of my pet(s) in this program to anyone not authorised. I understand should I disclose any such information to a non-authorised person this agreement is null and void and I will have 48 hours to reclaim my pet(s) from the AWLQ. 6. The AWLQ and/or its designated off-site foster care provider will provide daily food, water, socialisation, exercise and basic preventative care for my pet(s). 7. I understand that AWLQ reserves the right to seek veterinary care without my approval including administering treatments, medications and surgery. I acknowledge that should Veterinary care and attention for the animal be warranted, the AWLQ may provide only the minimum care the comfort and stabilise the animal. Should my pet(s) require extended veterinary care, I agree to reimburse the AWLQ for any veterinary attention or medication needed. However I understand that I will be informed prior to any such procedure. 8. Your pet will be health checked, vaccinated (if no record of vaccinations or vaccinations are outdated) and scanned for a microchip (the pet being microchipped and vaccinated is a compulsory requirement for admission to the program). 9. Should I fail to reclaim my pet by the designated time I understand and agree I will relinquish permanent ownership and custody of such animal to the AWLQ. 10. I consent to the Animal Welfare League QLD obtaining my animal(s) full medical vet history from the vet clinic disclosed under 'Animal Medical History', for Emergency Boarding purposes. ** The EB Co-Ordinator may sign this on the owner’s behalf if completed remotely and verbal permission is given by the owner. Please sign here to acknowledge T&C 8 of the AWLQ Emergency Boarding Admission Form:Name of owner of pet *Signature of owner * Clear Signature DateName of case worker/authorised person *Signature of case worker/authorised person * Clear Signature DatePreviousSubmit