W.I.S.H Rescue Surrender Application

Please note: Completing this form does not guarantee W.I.S.H Rescue will be able to take your pet. Intake depends on capacity, behavioural and medical needs, and foster availability. A member of our team will be in touch after review.

OWNER INFORMATION -
First Name: *
Surname: *
Address: *
Suburb: *
Postcode: *
Phone: *
Email: *
Confirm email
Drivers Licence Number: *
ANIMAL INFORMATION -
Species: *	Cat Dog
Animal's Name: *
Breed (best guess if unknown): *	Abyssinian Affenpinscher Afghan Hound Airedale Terrier Akbash Akita Alaskan Malamute American Bulldog American Curl American Eskimo Dog American Shorthair American Staffordshire Terrier American Water Spaniel American Wirehair Anatolian Shepherd Appenzell Mountain Dog Applehead Siamese Australian Cattle Dog/Blue Heeler Australian Kelpie Australian Shepherd Australian Terrier Balinese Basenji Basset Hound Beagle Bearded Collie Beauceron Bedlington Terrier Belgian Shepherd Dog Sheepdog Belgian Shepherd Laekenois Belgian Shepherd Malinois Belgian Shepherd Tervuren Bengal Bernese Mountain Dog Bichon Frise Birman Black and Tan Coonhound Black Labrador Retriever Black Mouth Cur Bloodhound Bluetick Coonhound Bobtail Bombay Border Collie Border Terrier Borzoi Boston Terrier Bouvier des Flanders Boxer Boykin Spaniel Briard British Shorthair Brittany Spaniel Brussels Griffon Bullmastiff Bull Terrier Burmese Burmilla Cairn Terrier Calico Canaan Dog Canadian Hairless Cane Corso Mastiff Carolina Dog Catahoula Leopard Dog Cattle Dog Cavalier King Charles Spaniel Chartreux Chesapeake Bay Retriever Chihuahua Chinchilla Chinese Crested Dog Chinese Foo Dog Chocolate Labrador Retriever Chow Chow Clumber Spaniel Cockapoo Cocker Spaniel Collie Coonhound Corgi Cornish Rex Coton de Tulear Cymric Dachshund Dalmatian Dandi Dinmont Terrier Devon Rex Doberman Pinscher Dogo Argentino Dogue de Bordeaux Domestic Long Hair Domestic Medium Hair Domestic Short Hair Dutch Shepherd Egyptian Mau English Bulldog English Cocker Spaniel English Coonhound English Pointer English Setter English Shepherd English Springer Spaniel English Toy Spaniel Entlebucher Eskimo Dog Exotic Shorthair Extra-Toes Cat (Hemingway Polydactyl) Field Spaniel Fila Brasileiro Finnish Lapphund Finnish Spitz Flat-coated Retriever Foxhound Fox Terrier French Bulldog German Pinscher German Shepherd Dog German Shorthaired Pointer German Wirehaired Pointer Glen of Imaal Terrier Golden Retriever Gordon Setter Great Dane Greater Swiss Mountain Dog Great Pyrenees Greyhound Havana Havanese Himalayan Hound Hovawart Husky Ibizan Hound Illyrian Sheepdog Irish Setter Irish Terrier Irish Water Spaniel Irish Wolfhound Italian Greyhound Italian Spinone Jack Russell Terrier Japanese Bobtail Japanese Chin Javanese Jindo Kai Dog Karelian Bear Dog Keeshond Kerry Blue Terrier Kishu Kokoni Komondor Korat Kuvasz Kyi Leo Labrador Retriever Lakeland Terrier Lancashire Heeler Leonberger Lhasa Apso Lowchen Maine Coon Maltese Manchester Terrier Manx Maremma Sheepdog Mastiff McNab Miniature Pinscher Mixed Breed Mountain Cur Mountain Dog Munchkin Munsterlander Neapolitan Mastiff Newfoundland Dog New Guinea Singing Dog Norfolk Terrier Norwegian Buhund Norwegian Elkhound Norwegian Forest Cat Norwegian Lundehund Norwich Terrier Nova Scotia Duck-Tolling Retriever Ocicat Old English Sheepdog Oriental Long Hair Oriental Short Hair Oriental Tabby Otterhound Papillon Patterdale Terrier (Fell Terrier) Pekingese Persian Peruvian Inca Orchid Petit Basset Griffon Vendeen Pharaoh Hound Pit Bull Terrier Pixie-Bob Plott Hound Pointer Polish Lowland Sheepdog Pomeranian Poodle Portugese Podengo Portuguese Water Dog Presa Canario Pug Puli Pumi Ragamuffin Ragdoll Rat Terrier Redbone Coonhound Retriever Rhodesian Ridgeback Rottweiler Russian Blue Saint Bernard St. Bernard Saluki Samoyed Schipperke Schnauzer Scottish Deerhound Scottish Fold Scottish Terrier Scottie Sealyham Terrier Selkirk Rex Setter Shar Pei Sheep Dog Shepherd Shetland Sheepdog Sheltie Shiba Inu Shih Tzu Siamese Siberian Siberian Husky Silky Terrier Singapura Skye Terrier Sloughi Smooth Fox Terrier Snowshoe Somali South Russian Ovcharka Spaniel Sphynx (hairless cat) Spitz Staffordshire Bull Terrier Swedish Vallhund Terrier Thai Ridgeback Tibetan Mastiff Tibetan Spaniel Tibetan Terrier Tiger Tonkinese Tosa Inu Toy Fox Terrier Treeing Walker Coonhound Turkish Angora Turkish Van Vizsla Weimaraner Welsh Corgi Welsh Springer Spaniel Welsh Terrier West Highland White Terrier Westie Wheaten Terrier Whippet White German Shepherd Wire-haired Pointing Griffon Wirehaired Terrier Xoloitzcuintle/Mexican Hairless Yellow Labrador Retriever Yorkshire Terrier Yorkie
Age/DOB (estimate if unknown): *
Sex: *	Male Female
Has the animal been desexed?: *	Not known Yes No
Has the animal been Microchipped?: *	Not known Yes No
Microchip Number: *
Is the animal upto date with its annual vaccinations?: *	NoYes
Date of last vaccination (if known):
HEALTH & BEHAVIOUR -
Does the animal have any known medical issues?: *	Not known Yes No
If yes, please detail:
Is the animal currently on medication, specialised diet or receiving any medical treatment?: *	Not known Yes No
If so, please specify:
Has the animal ever bitten or attacked another animal or person?: *	Unsure Yes No
If so, please specify:
Has the animal shown aggression towards people?: *	Untested Yes No
If so, please specify:
Has the animal shown aggression towards children?: *	Untested Yes No
If so, please specify:
Has the animal shown aggression towards dogs?: *	Untested Yes No
If so, please specify:
Has the animal shown aggression towards cats?: *	Untested Yes No
If so, please specify:
Has the animal shown aggression towards animals, other than cats and dogs? *	Untested Yes No
If so, please specify
BEHAVIOUR & LIFESTYLE -
Is the animal housetrained?: *	NoYes
Does the animal have any separation anxiety?: *	Unsure Yes No
If so, please specify
Does the animal walk well on leash (dogs)?:	Untested Yes No
Where does the animal live/sleep?: *	Indoors Only Outdoors Only Both
Is the animal crate trained (dogs)?:	Untested Yes No
Has the animal ever shown destructive behaviour?: *	Unsure Yes No
If so, please specify
Has the animal ever attempted to or escaped?: *	Unsure Yes No
If so, please specify:
Does the animal resource guard (hides items, becomes aggressive/protective of items/people/food/water ect.)?: *	Unsure Yes No
If so, please specify:
Does the animal travel well in cars?: *	NoYes
Is the animal reactive to grooming/bathing?: *	Untested Yes No
If so, please specify:
Is the animal reactive when visiting the vet?: *	Untested Yes No
If so, please specify?:
REASON FOR SURRENDER -
Please explain the reason for surrendering the animal: *
ADDITIONAL DETAILS -
Is there anything else you'd like us to know to help us care for or rehome your pet? *
PHOTOS -
Please email 2-4 clear photos of the animal (face, full body, with people if possible) to admin@wishrescue.net
OWNER DECLARATION -
By signing this form, I confirm that:
*	I am the legal owner of the animal described above.
*	I have provided accurate and complete information.
*	I am willing to present photo ID, to a W.I.S.H Rescue representative.
*	I will provide proof of ownership for the animal described above.
*	I understand that W.I.S.H Rescue may not be able to accept the animal into care and will advise me of the application outcome once it has been reviewed.
Signature: *	Clear
Date: *	NoYes