Little Legs Dog & Cat Rescue QLD Inc

Last Litter Program Application Form

Please ensure all fields with an asterisk ( * ) are completed as blank fields will prevent the form from submitting.

IMPORTANT INFORMATION:
You must be the owner of the mother to be eligible for the Last Litter Program.
Submission of this form does not guarantee assistance as this program is extremely limited. However we endeavour to help as many as we can and will be in touch asap regarding your application.

1. Owners First Name *
2. Owners Last Name *
3. Owners Address *
4. Owner's Suburb *
5. Owner's postcode *
6. Best contact number *
7. Email *
8. Type of Litter you would like to surrender *	Dog Kitten
8a. Number in Litter & their sexes * If the litter is not yet born, please note that in this section.
9. Date of Birth of the litter * If the litter is not yet born, please write the estimated due date.
10. Breed of Mother *
11a. Breed of father (if known)
12. Approx age of mother *
13. Are you the Legal Owner of the mother? *
14. Is the mother and litter up to date with flea and/or worming treatments? *
14a. If yes, when were they last given a flea treatment and what brand was it?
15. Does the mother have any health problems? If so please list *
16. Has the litter been exposed to children *
17. Has the Litter been exposed to dogs? *
18. Has the Litter been exposed to cats? *
19. Does the family sleep indoors or outside? *
Photo of your animal *
Photo of the Litter * if not yet born, upload another image of the mother.
I declare the above information to be true and correct to my knowledge and I understand it is an offence to provide false or misleading information and that I can be held liable. I confirm I am the legal owner of the mother. *

By submitting this application you are agreeing to the following Terms & Conditions. Little Legs Dog & Cat Rescue QLD Inc will pay for the dam of your surrendered litter to be desexed at one of our vets, as soon as she is medically fit to undergo the procedure. The owner of the Dam will surrender the entire litter to Little Legs Dog & Cat Rescue QLD Inc (LLSQLD). The owner is liable for any added expenses incurred for the Dam from any complications that may arise from the surgery. The owner of the Dam understands that while a desexing surgery is routine, complications can arise which may result in serious ongoing health conditions, even death and will not hold LLSQLD liable. Submission of this application is subject to approval from LLSQLD.Please keep an eye on your email, both inbox and spam folder, for any updates relating to your application.