BARRC Animal Surrender Request

As a requirement under the Dog Act 1976 all dogs must now be microchipped prior to rehoming. A surrender fee of $40.00 per dog is requested to cover this cost. If the dog for surrender is already microchipped the fee will be utilised in covering other expenses incurred by BARRC. BARRC is a not for profit organisation and receives no government funding. Therefore, donations are welcomed. Answering Yes to the following questions does not rule out the opportunity to rehome your pet. We appreciate your honesty to ensure the best outcome for the animal.
Details of Animal you require assistance to rehome
Name of Animal *
Sex of Animal *
Breed of Animal *
Size of Animal *
Age of Animal *
Is the animal sterilised? *
Is your dog current with vaccinations? *
Next vaccination due date.
Do you have current vet records that you can provide at time of surrendering? *
Are you the lawful owner of this animal? Is the dog microchipped in your name?
Please provide microchip number. *
Is this dog registered with a shire council? If yes,please provide shire name.
Please provide details on reason for surrendering your pet. *
Please provide a photo of the dog. upload a photo from your computer or phone and attach. Photographs are an essential part of enabling BARRC to find the most suited foster/new home match for the dog as they help depict the size and breed of the dog.
Please attach any further photo you may wish to share of the dog.
Animal Information
Does the dog have any health issues or had any previous procedures/treatment? *
If Yes,please provide details Remember to also include any medication/treatment that the animal is currently taking or requires long term.
Does your dog have a special diet requirement? Please provide brand name and flavour of food product dog is currently receiving. *
How long have you had this pet and where did you obtain him/her from? *
Exercise: What form of exercise do you provide for the animal? For example: daily on lead walks; dog exercise park; backyard play or nil *
Describe your property fencing (material and height) * Please describe the height and materials of your fencing
On an average day, how many hours is the animal on its own without human company? *
How does the animal behave when left alone without human company? (eg dig, bark, attempt to escape) *
Is the animal best suited to a home with/without another dog? Please explain reason. *
Please list the animals favourite games,activities,toys * eg swimming; ball play; quiet walks only
Does this animal escape the yard? * Please select Yes or No. If yes, indicate how the animal is getting out of the property
What animals is your dog compatible with? (dogs, cats, sheep, chickens etc) *
Does your dog get along with other dogs? *
Please provide further details on other dog interactions (eg compatible only with small dogs; female dogs;) *
This animal is social with cats *
Does this animal share the home with or interact on a regular basis with children? *
Has this dog shown signs of aggression, reaction or fear toward children? *
Please provide further details on interactions with children, including their ages. *
Animal Behaviour and Habits
Select as many of the following that describe the dog’s behaviour and habits *
Is this pet housetrained? *
Where does this animal sleep? * Provide details on indoor/outdoor/kennel/on couch etc
Has this animal ever bitten people? *
If Yes, please provide details
Has this animal every growled/snarled at people? *
If Yes, please provide details
Has this animal ever bitten another animal? *
If Yes,please provide details
Has this animal every growled/snarled at other animals? *
If yes,please provide details
Where did you hear about BARRC? *
Owner Details
First Name *
Surname *
Street Address *
Suburb
Town or City *
Postcode *
Email *
Phone *
Proof of Identity Please provide a photo of one of the following forms of identification. At least one must show a signature:
Drivers Licence; WWC; Passport; Student Identity document; Centrelink Concession Card; Proof of Age Card
Proof of Identification
Proof of Identification
By submitting this surrender form you:
1. Warrant that you are the legal owner of the animal and/or have the authority to surrender the animal.
2. Relinquish all ownership rights of the animal and agree that the animal becomes the property of BARRC.
3 . Understand that rehousing of the animal listed in this surrender form will be completed by BARRC on the basis the animal is deemed suitable for rehousing and that every effort will be made to ensure the animal is provided with this opportunity.
4. Understand that the surrender fee is non refundable.
5. Agree that all information provided is accurate, truthful and correct to the best of your knowledge.
6. Confirm that you are over 18 years of age. I have read, understand and agree to abide by the above surrender terms and conditions.
SIGNATURE Required. Note: If using computer,please hold mouse left click and sign. *
Dated *