Intake request for SMALL ANIMALS

RSPCA

Questionnaire to relinquish SMALL ANIMAL(S) to the RSPCA Worcester and mid-Worcestershire branch

The information you give us will be used by our staff only as a source of background information on your small animal(s) who you need to rehomed.
We do not discriminate when it comes to animals that we accept into our care, so please be honest with the information you provide,
as this will give us the best insight into your small animal's background and behaviours, and will help us find the most suitable home for them.

Small animals that we can take in and rehome are as follows; guinea pigs, hamsters, mice, rats, degus and gerbils.
For all other animals, please email us at emily@rspcaworcester.org.uk and we will see if we can help.

All personal information supplied by you on this application form will be processed by the Royal
Society for the Prevention of Cruelty to Animals whose privacy policy is available and published
at www.rspca.org.uk/privacy or on request by calling Supporter Services on 0300 123 0346.
This applies whether the information is supplied directly to national RSPCA (charity number 219099),
as data controller, or is shared with us by an RSPCA Branch (RSPCA Worcester is a separately
registered charity no 205930) as a joint data controller. The term "RSPCA" will refer to both data controllers.

A FEW DETAILS ABOUT YOU
Title *
First name *
Surname *
Address *
Town *
County
Postcode *
Best phone number to contact you on *
Email address *
What species of animal do you wish to relinquish into our care? *
If other, please state which species you would like to relinquish into our care
Are you the legal owner of the animal(s)? *
If you are not the legal owner of the animal(s) please state your relationship to the legal owner
Please state the reason you're needing to relinquish? *
Where did you purchase your animal(s) *
What age was your animal(s) when they came into your care?
WHERE DID YOU HEAR ABOUT US?
Please advise how you heard about RSPCA Worcester & Mid-Worcestershire Branch
If other, please state where
YOUR ANIMALS DETAILS
How many animals do you wish to relinquish into our care? *
If you wish to relinquish more than one animal are they...
Please attach an image of the animal you would like to relinquish *
Optional extra image
Optional extra image
Optional extra image
Name of animal(s) *
Age of animal(s) (please select multiple options if they are different ages) *	0-3months 3-6 months 6-12 months 1-2 years 3-5 years 6+ Unsure
Gender of animal(s) *
Colour of animal(s) *
Size of animal(s) *
what breed is your animal(s)? *
A LITTLE BIT ABOUT YOUR ANIMAL(S)
Please describe your animals(s) personality *
Please descibe what type of accommodation your animals(s) is in *
Please attach a picture of your animal's accommodation
Optional extra image
Optional extra image
Does your animal(s) currently have any medical problems, or have they had any medical problems in the past? If yes, please explain the issues. *
Please describe your animal's diet and what they are fed (i.e brand of food) *
Does your animal have a water bowl or a water bottle? *
Is there anything else you would like us to know? *
Signature
Date *
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Intake request for SMALL ANIMALS

Questionnaire to relinquish SMALL ANIMAL(S) to the RSPCA Worcester and mid-Worcestershire branch

A FEW DETAILS ABOUT YOU

WHERE DID YOU HEAR ABOUT US?

YOUR ANIMALS DETAILS

A LITTLE BIT ABOUT YOUR ANIMAL(S)