Surrendering Your Animal
To help us better understand you and your animal's needs, please complete the questionnaire as fully and as honestly as possible. Your experience with this animal will provide us with valuable information to help us find a home that will cater to its unique needs.
Owner Details
First Name
*
Last Name
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 0000000000.
Your Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Day
-
Month
Year
Date
Driver License Number
Which RSPCA QLD Shelter is closest to your animal?
*
Please Select
Brisbane, Wacol
Bundaberg
Cairns
Dakabin (Must reside in MBRC)
Gympie
Mackay
Rockhampton
Toowoomba
Secondary Contact Name
First Name
Last Name
Secondary Contact Number
Please enter a valid phone number.
Format: 0000000000.
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Animal Details
What type of animal do you need to surrender?
*
Please Select
Dog
Cat
Puppies/Kittens (Under 12wks) inc. litters
Bird/Poultry
Reptile
Small Animal
Farm Animal
Pet's Name
*
Pet's Date of Birth (Approx.)
*
-
Day
-
Month
Year
Date
Pet's Gender
*
Please Select
Male
Female
Uknown
What is your pet's breed or species?
*
Describe your pet's personality
*
What is your pet's microchip number?
If unknown, please leave blank.
Where did you get your pet from?
*
How long have you owned this animal?
*
What is the reason(s) you need to surrender your pet?
*
Activity level of animal
Allergies
Anxiety of animal
Barking
Body Corp. won't allow
Can't afford behaviour training
Can't afford medical care
Destructive
Do not want pet
Escaping (jumping, digging, breaking through)
Landlord won't allow
Moving overseas
Other household pet/s not good with this pet
Owner deceased
Owner going into care facility - no pets allowed
Owner health
Owner homeless
Toileting inappropriately
Too many animals
Unsafe / untrustworthy to animals
Unsafe / untrustworthy to people
Unwanted litter
Is there anything that would help you keep your pet?
Upload a picture of your pet
*
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Animal Health
Is your pet desexed?
*
Please Select
Yes
No
Unknown
Please advise any vet clinics your pet has been taken to
*
By submitting this application, you are consenting to RSPCA Qld requesting your pet's medical history.
How does your pet behave at the vet?
*
Does your pet have any signs of illness or injury that concern you? Please provide as much detail as possible.
*
If your pet has ever been diagnosed with a medical condition by a vet, please provide these details.
*
If your pet is on any prescribed medication or diets, please provide these details.
*
If your pet is on any health, food or behavioural supplements, please provide these details.
*
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Home Life
How would you describe your household/home environment?
*
Please Select
Calm/quiet
Active/busy/highly stimulating
In between
How many people, of what age groups, live in your home?
*
What interaction does your pet have with children? (Including outside your immediate family)
*
How long does your pet spend alone without humans?
*
Please Select
Someone is usually home full time
Short periods (1-2hrs day)
Less then 6hrs
10-12hrs a day
13hrs+
Does your pet live with any other animals?
*
Please provide species, age, gender, if they interact and are they safe together
Where does your pet sleep at night?
*
Is your pet allowed on the furniture?
*
Please Select
Yes - any furniture
Yes - specific furniture
No
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Training & Behaviour
Have you done any training with your pet? How do you train them?
*
What food does your pet regularly eat (meals & treats)
*
Does your pet play with toys? What toys and when?
*
Describe where your pet chooses to spend its day
*
How does your pet react to being fed around other pets?
*
How does your pet react to being fed around people?
*
If your pet follows you from room to room, or always appears to be at your feet, please provide details regarding this behaviour.
*
How frequently do you groom your pet and what type of grooming?
*
Has your pet ever injured another animal, what happened?
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Please provide as much detail as possible - type of animal, nature of injury, did the injury bleed, was the animal known or unknown by your pet
Has your pet ever intentionally bitten or injured someone?
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Please provide as much detail as possible - did the person live in the home, what happened immediately before the incident, was the pet injured/scared?
How does your pet react to seeing animals of other species?
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What type of animal, what happens, is it consistent?
How does your pet react to seeing animals of its species?
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What happens, is it consistent?
How does your pet react when people enter your home?
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What happens, is it consistent and does it change based on age or gender?
Is there anything that frightens or distresses your pet?
*
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Dog Assessment
What is your dog's Breeder Supply Number (BIN) or Breeder Exception Number (BEN)?
If you do not have a BIN or BEN, you can register online with the Qld Government: https://qdbr.daf.qld.gov.au RSPCA Queensland requires a BIN or BEN for dogs born on or after 26 May 2017.
Is your dog toilet trained?
*
Please Select
Yes
No
Mostly
Is your dog allowed inside?
*
Please Select
Yes - mostly
Yes - sometimes
No
Describe the fencing on your property
*
Please include height in metres, material, visual barrier and other details
Does your dog bark at or chase along the fence line?
*
Please Select
Yes - Other dogs
Yes - Anything that goes past
No
When left alone, how does your dog act?
*
Please Select
Bark/howl/cry for a short time then settles
Bark/howl/cry the entire duration
Destroys structural items, such as doors or walls
Destroys furniture or toys, digs holes
Desperately tries to escape
Settles easily
Has your dog escaped from the property? How did they escape?
*
If yes, please indicate the frequency in which your dog has escaped
Please Select
Daily when no-one is home
Daily even if someone is home
Weekly
Monthly
Only ever escaped once or twice; not recently
Only during storms
If your dog has ever injured themselves when trying to escape, please provide details.
How often and where do you exercise your dog?
*
Is your dog chained?
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No - dog is not chained
Yes - to prevent escape (fencing insufficient)
Yes - it's too big and boisterous
Yes - for safety of other animals
Yes - for safety of people
Other
Does your dog travel well in the car?
*
Please Select
Yes
No
Unsure
Does your dog vocalise (bark/howl/cry/talk) excessively?
*
Please Select
Consistently - with stimuli or reason
Consistently - without stimuli or reason
Inconsistently - with stimuli or reason
Inconsistently - without stimuli or reason
Hardly ever
Other
Does your dog display obsessive or repetitive behaviours like chasing it's tail or shadow? If so, please explain
*
Have you used any of the following to attempt to correct behaviour?
*
E collar / shock collar
Prong collar
Alpha roll
Dog boot camp
Treats &/or clicker
None of the above
How does your dog interact in busy areas?
*
Please Select
Safely without incident
Becomes aggressive
Becomes fearful/stressed/nervous
N/A - it's ever been in a busy location
Do you muzzle your dog?
*
When around other dogs
When around people
When outside of the home
When at the vet
Never
Has your dog had any council restrictions or directives placed upon it?
*
Yes - declared dangerous &/or menacing
Yes - noise compliance
Yes - roaming/at large
No
Cat Assessment
Is your cat exclusively kept inside?
*
Please Select
Yes
No
Where does your cat go to the toilet?
*
Litter tray or outside? If in a litter tray, where is it located? What type of litter? How many trays are available and of what tray type?
Has your cat ever urinated outside the designated space?
*
Where did they urinate and were there any changes to the home at that time? What action was taken?
Has your cat ever defecated outside the designated space?
*
Where did they defecate and were there any changes to the home at that time? What action was taken?
Does your cat show any of the following behaviours?
*
Scratch furniture
Vocalising
Jumping up on counters
Chew plants
Chew electric cords
Climbing curtains
Spraying
Escaping – breaking through screens to get out
None of the above
Has your cat scratched anyone? Please explain
*
Does your cat show aggressive behaviours/lash out at any time without engagement or interaction? If so, please describe.
*
Bird & Poultry Assessment
Is your bird hand tame?
*
Describe how and when your bird is handled and by whom
Describe your bird's housing
*
Please include enclosure type, size and location in your home
How long does your bird spend out of their housing?
What enrichment do you provide your bird?
Foraging
Rope toys
Native browse & flowers
Daily training
Mirror
Other
None
Any previous behavioural issues?
*
Please Select
No
Screaming
Feather plucking
Aggression
Other
Reptile Assessment
What is the approximate length of the reptile you wish to surrender?
*
What is your Wildlife Permit Type, Number and Expiry
*
Describe your reptile's housing
*
Please include the location in your home, lighting and heating details
Has your reptile been housed with other reptiles?
*
Please include details
What type of handling has your reptile had?
*
Include frequency, age of handler, and type of handling
Describe your reptile's feeding arrangements
*
When did your reptile last shed?
*
Kitten / Puppy / Litter Assessment
Are you surrendering a kitten or puppy under the age of 12wks?
*
Please Select
Kitten/s under the age of 12wks
Puppy/s under the age of 12wks
How many are in the litter?
*
What is your Breeder Supply Number (BIN) or Breeder Exception Number (BEN)?
If you do not have a BIN or BEN, you can register online with the Qld Government: https://qdbr.daf.qld.gov.au/ RSPCA Queensland requires a BIN or BEN for dogs born on or after 26 May 2017.
Small Animal Assessment
Which type of small animal do you wish to surrender?
*
Please Select
Guinea Pig
Rat
Mouse
Other
Describe your pets current housing
*
Please include details like enclosure type, size and location in your home
What type of handling has your pet had?
*
Include frequency, age of handler, and type of handling
Farm Animal Assessment
What type of farm yard animal do you wish to surrender?
*
Describe your animals current housing
*
Please include details like fence type, shelter and available troughs
What type of handling has your animal had?
*
Include frequency, age of handler, and type of handling
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Owner Assessment
Please indicate whether you feel the following arrangements would suit your pet
Living with a dog
*
Please Select
Yes
No
Living with a cat
*
Please Select
Yes
No
Living with an elderly or frail person or couple
*
Please Select
Yes
No
Living in a unit
*
Please Select
Yes
No
Living in the suburbs
*
Please Select
Yes
No
Living on acreage
*
Please Select
Yes
No
Living with children 0-8 years
*
Please Select
Yes
No
Living with children aged 9-16 years
*
Please Select
Yes
No
Living in a home without children
*
Please Select
Yes
No
Do you feel that your pet will cope with being housed in a busy shelter environment, with a large number of other animals in close proximity, a large number of unfamiliar people and noises?
*
Please Select
Yes
No
With your knowledge, do you believe this pet is behaviourally sound and not likely to cause harm to other people, animals or itself and that it is physically healthy to be rehomed to someone looking for a new family member?
*
Please Select
Yes
No
Please share any other comments or information that would be useful for us or the new owner to know
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