Geelong Animal Welfare Society
Animal Surrender Form
By completing this form you are giving GAWS a written consent to
relinquish all rights to your companion animal. To ensure the best
possible outcome of your pet, please complete this form thoroughly.
This will assist our staff when conducting health and
behavioural assessments. Your honest answers are necessary to
ensure that we can find the most suitable home for your pet.
Owner’s name:
Address:
Contact number:
Email address:
Animal Information (please complete one form per animal)
Animal’s name:
Species: DOG / CAT / OTHER:
Breed:
Colour:
Sex: M / F
Desexed: YES / NO
Birth date/Age:
Why are you surrendering this animal?
How long have you had this animal?
Where did you get this animal from (e.g. shelter, pet shop, breeder, etc.)?
Does your pet live with any other animals? YES / NO
If Yes, what animals? E.g. dogs, cats, rabbits, livestock, etc.
How does your animal usually behave toward the following?:
Familiar people:
Unfamiliar people:
Children:
Familiar dogs:
Unfamiliar dogs:
Cats:
Other (please specify):
DOGS ONLY – Does your dog display any of the following behaviours?
Excessive barking?
Destructive behaviours?
Serial escaping?
DOGS ONLY – Has your dog had any training?
If yes, please specify: E.g sit, stay, drop, lead walking, etc.
CATS ONLY – Does your cat display any of the following behaviours?
Spraying (urine)?
Destructive behaviour (clawing)?
YES / NO
YES / NO
YES / NO
YES / NO
YES / NO
YES / NO
Where does your pet usually sleep?
Is your pet toilet (or litter) trained?
a.
YES / MOST OF THE TIME / NO
What endearing traits does your pet have that you would like a new owner to know?
Shelter Dogs | www.centerforshelterdogs.com
Does your pet regularly see a veterinarian?
YES / NO
If yes, which vet clinic?
How does your pet behave at the vet?
Does your pet have any past or present medical conditions?
Is your dog currently on any medication?
YES / NO
If yes, please describe medication, reason and dosage
Is your pet up to date with their vaccination?
YES / NO
If yes, have you brought in their vaccination certificate?
YES / NO
Any other comments:
Surrender Conditions:
1) I am the owner of the above mentioned animal and declare that no
other person has any property interest therein.
2) I hereby surrender all rights, title and interest in the said animal to the
GEELONG ANIMAL WELFARE SOCIETY and agree that the said
animal will become the sole and absolute property of the Society which
is hereby authorised to hold, sell, destroy or dispose of this animal as
the Society discretion.
3) I hereby agree to indemnify the Society and keep the Society so
indemnified against all claims (if any), costs and expenses whatsoever
arising from any action by any person claiming interest contrary to that
expression in Paragraph on hereof.
4) By signing below, I certify that the information provided is accurate and
truthful to the best of my knowledge.
Name:
Date:
Signature:
GAWS use only
Animal ID:
Vaccination certificate provided? YES / NO
Other papers provided? YES / NO
Please specify:
Desexing certificate provided? YES / NO
Staff initial: