Assisted Re-home/Surrender Form Assisted Rehoming/Surrender Form Personal DetailsMPORTANT NOTE PLEASE READ BEFORE FILLING FORM OUT Golden Oldies Animal Rescue have limited carers and receives no Government funding and relies on donations to run. We receive a high number of surrender and rehoming applications. Golden Oldies Animal Rescue have no paid staff and run on an entirely volunteer basis. With this in mind please understand we cannot always assist with dogs needing surrender or rehoming due to the lack of time, volunteers, finances and under some other circumstances. We will endeavour to get back to you to let you know if we can help and if by chance we don't reply please do not resubmit your form as that will create a longer delay in processing each request. Please contact us via facebook if you have any concerns. I have read this and understand Golden Oldies cannot guarantee they can assist me in my request. I have read this*I AgreeWe need to know how long you can care for the pet you are wishing to surrender or wanting assisted rehoming for. The longer you give us the better chance we have of being able to help your pet find a new home.*We require a Date, day, month, and year. Please Note: Please enter a firm date or "Emergency" if urgent re-homing is requiredIf this an Emergency, please indicate here*Please be specific Reason for contact?Assisted RehomeSurrenderAssisted re-home/surrenderDate* First Name*Last Name*Address* Unit and or Street Number Street Name Suburb State Post Code Phone*Work or other Phone NumberEmail* Relationship to PetI am the Legal OwnerLegal Owner's Next of KinFriendOtherDetails of your relatioship to Pet and Legal OwnerMunicipality/Council*Details and InformationPet's namePet's BreedPet's agePet Size?SmallMediumLargeIs the Pet MicrochippedYesNoUnsurePlease enter Microchip numberIf possible, please provide name and/or details of Vet, carer, former owner who might provide Microchip details?Please give details of age, sex, temperament, activity levelDoes Pet have any behavioural or socialisaton problems?*YesNoPlease give detailsPlease include things such as Likes to climb fences, bites, barks excessively etc,.Does Pet get along with other Dogs/animals?YesNoUnsurePlease give as much detail as possiblePlease include things such as same sex dog aggressive, dislike small/big dogs, dislikes CatsHas Pet lived with/been socialised with Children?YesNoUnsurePlease give detailsChildren(s) ageIs pet desexed?YesNoUnsurePlease give details*Is pet up to date with vaccinations?*YesNoUnsureDoes Pet have any health issues?*YesNoUnsurei.e. requires dental work, skin conditions etc,.Please list current Health Problems?Please list all issues, the more detail the better, such as, Dental work needed, old injuries, lumps, skin conditions, allergies, blindness, deafness, tumors etc.,By completing this form I agree that Golden Oldies Animal Rescue charge a $100 Assisted Rehoming Fee. Payable when my pet is accepted to be re-homed.*I AgreeBy completing this form I agree that Golden Oldies Animal Rescue will endeavour to assist to the best of their ability to assist in rehoming my pets. I understand in some circumstances Golden Oldies Animal Rescue are unable to find a new home for my pet and at all times during this process and I am fully responsible for my pet.*I AgreeI understand that GOAR will require adequate time to help re-home my pet and appreciate the length of time it takes to find the right home.*I AgreeBy completing this form I guarantee I can supply all necessary paperwork such as desexing certificates, microchip paperwork, vaccination records and documentation of ownership.*I AgreeI agree I am the registered owner of the above pet or acting upon the owner's behalf with their permission. I confirm that the information provided is truthful to the best of my knowledge.*I AgreeI am agreeing to the afore mentioned fee. I am engaging the services of Golden Oldies Animal Rescue to assist me in rehoming my pet.*I AgreeI acknowledge that the pet remains my responsibility and the final decision on who I rehome my pet to is mine and understand Golden Oldies accepts no responsibility if the new owner is not suitable for my pet, I need to take the pet back into my care if this occurs. At no time is the pet the property or responsibility of Golden Oldies Animal Rescue nor any future needs of my dog.*I AgreeI acknowledge that Golden Oldies Animal Rescue is not responsible for any costs you incur now or into the future*I AgreeI am over the age of 18 years*Legally you must over the age of 18 to adopt an animalYesNoI have not provided false information. All information supplied is true and correct and in no way misleading.* Agree Date* Name* First Last You may be asked to sign this form at a later date in the process. We will be in touch very soon!NameThis field is for validation purposes and should be left unchanged.