Cat Surrender Application
Cat Surrender Application
Owner First Name
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Owner Surname
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Street Address
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City
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State
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Post Code
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Phone Number
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Email Address (non NT Gov or NT Schools email addresses please)(Please check spam folder as you will get an automatic email once you submit this form and future emails may also go there)
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Animal Name
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Gender
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Male
Female
Breed
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Abyssinian
Affenpinscher
Afghan Hound
African Grey
Agile wallaby
Airedale Terrier
Akbash
Akita
Alaskan Malamute
Amazon
American
American Bulldog
American Curl
American Eskimo Dog
American Fuzzy Lop
American Sable
American Shorthair
American Staffordshire Terrier
American Water Spaniel
American Wirehair
Anatolian Shepherd
Angora Rabbit
Antilopine wallaroo
Appaloosa
Appenzell Mountain Dog
Applehead Siamese
Arabian
Australian Cattle Dog/Blue Heeler
Australian Kelpie
Australian Shepherd
Australian Terrier
Balinese
Basenji
Basset Hound
Beagle
Bearded Collie
Bearded dragon
Beauceron
Bedlington Terrier
Belgian Hare
Belgian Shepherd Dog Sheepdog
Belgian Shepherd Laekenois
Belgian Shepherd Malinois
Belgian Shepherd Tervuren
Bengal
Bernese Mountain Dog
Beveren
Bichon Frise
Birman
Black and Tan Coonhound
Blackheaded Flying fox
Blackheaded python
Black Labrador Retriever
Black Mouth Cur
Bloodhound
blue heeler
Bluetick Coonhound
Blue tongue lizard
Bobtail
Boer-Boel
Bombay
Border Collie
Border Terrier
Borzoi
Boston Terrier
Bouvier des Flanders
Boxer
Boykin Spaniel
Briard
Britannia Petite
British Shorthair
Brittany Spaniel
Brotogeris
Brushtail possum
Brussels Griffon
Budgie/Budgerigar
Bull Arab
Bullmastiff
Bull Terrier
Bunny Rabbit
Burmese
Burmilla
Caique
Cairn Terrier
Calico
Californian
Canaan Dog
Canadian Hairless
Canary
Cane Corso Mastiff
Carolina Dog
Catahoula Leopard Dog
Cattle Dog
Cavalier King Charles Spaniel
Champagne DArgent
Chartreux
Checkered Giant
Chesapeake Bay Retriever
Chicken
Chihuahua
Chinchilla
Chinchilla
Chinchilla
Chinese Crested Dog
Chinese Foo Dog
Chocolate Labrador Retriever
Chow Chow
Cinnamon
Clumber Spaniel
Clydesdale
Cockapoo
Cockatiel
Cockatoo
Cocker Spaniel
Collie
Conure
Coonhound
Corgi
Cornish Rex
Coton de Tulear
Cow
Creme DArgent
Crossbreed
Cymric
Dachshund
Dalmatian
Dandi Dinmont Terrier
Darwin Special Large
Darwin Special Medium
Darwin Special Small
Devon Rex
Doberman Pinscher
Dogo Argentino
Dogue de Bordeaux
Domestic Long Hair
Domestic Medium Hair
Domestic Short Hair
Donkey/Mule
Dove
Draft
Duck
Dutch
Dutch Shepherd
Dwarf
Dwarf Eared
Eclectus
Egyptian Mau
Emu
English Bulldog
English Cocker Spaniel
English Coonhound
English Lop
English Pointer
English Setter
English Shepherd
English Spot
English Springer Spaniel
English Toy Spaniel
English Toy Terrier
Entlebucher
Eskimo Dog
Exotic Shorthair
Field Spaniel
Fila Brasileiro
Finch
Finnish Lapphund
Finnish Spitz
Fish
Flat-coated Retriever
Flemish Giant
Florida White
Flying fox
Foxhound
Fox Terrier
French Bulldog
French-Lop
Frilled neck
German Pinscher
German Shepherd Dog
German Shorthaired Pointer
German Wirehaired Pointer
Glen of Imaal Terrier
Goat
Golden Retriever
Goose
Gordon Setter
Great Dane
Greater Swiss Mountain Dog
Great Pyrenees
Greyheaded Flying fox
Greyhound
Guinea fowl
Guinea Pig
Harlequin
Havana
Havana
Havanese
Heeler Blue
Heeler Red
Himalayan
Himalayan
Holland Lop
Hotot
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
Jersey Wooly
Jindo
Kai Dog
Karelian Bear Dog
Keeshond
Kerry Blue Terrier
Kishu
Komondor
Koolie
Korat
Kuvasz
Kyi Leo
Labrador
Labrador Retriever
Lakeland Terrier
Lancashire Heeler
Leonberger
Lhasa Apso
Lilac
Little Red Flying fox
Llama
Lop Eared
Lory/Lorikeet
Lovebird
Lowchen
Macaw
Maine Coon
Maltese
Manchester Terrier
Manx
Maremma Sheepdog
Mastiff
McNab
Miniature Pinscher
Mini-Lop
Mini Rex
Missouri Foxtrotter
Morgan
Mountain Cur
Mountain Dog
Mouse
Munchkin
Munsterlander
Mustang
Mynah
Neapolitan Mastiff
Netherland Dwarf
Newfoundland Dog
New Guinea Singing Dog
New Zealand
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
Ostrich
Otterhound
Paint/Pinto
Palomino
Palomino
Papillon
Parakeet (Other)
Parrot (Other)
Paso Fino
Patterdale Terrier (Fell Terrier)
Peacock/Pea fowl
Pekingese
Percheron
Persian
Peruvian Inca Orchid
Peruvian Paso
Petit Basset Griffon Vendeen
Pharaoh Hound
Pheasant
Pigeon
Pig (Farm)
Pionus
Pit Bull Terrier
Pixie-Bob
Plott Hound
Pointer
Polish
Polish Lowland Sheepdog
Pomeranian
Pony
Poodle
Portugese Podengo
Portuguese Water Dog
Pot Bellied
Presa Canario
Pug
Puli
Pumi
Quaker Parakeet
Quarterhorse
Ragamuffin
Ragdoll
Rat
Rat Terrier
Redbone Coonhound
Retriever
Rex
Rhea
Rhinelander
Rhodesian Ridgeback
Ringneck/Psittacula
Rosella
Rottweiler
Russian Blue
Saddlebred
Saint Bernard St. Bernard
Saluki
Samoyed
Satin
Schipperke
Schnauzer
Scottish Deerhound
Scottish Fold
Scottish Terrier Scottie
Sealyham Terrier
Selkirk Rex
Setter
Shar Pei
Sheep
Sheep Dog
Shepherd
Shetland Sheepdog Sheltie
Shiba Inu
Shih Tzu
Siamese
Siberian
Siberian Husky
Silky Terrier
Silver
Silver Fox
Silver Marten
Singapura
Skye Terrier
Sloughi
Smooth Fox Terrier
Snake
Snowshoe
Softbill (Other)
Somali
South Russian Ovcharka
Spaniel
Sphynx (hairless cat)
Spitz
Squirrel glider
Staffordshire Bull Terrier
Staffy
Staffy x
Standardbred
Sugar glider
Sugar Glider
Swedish Vallhund
Tan
Tennessee Walker
Terrier
Thai Ridgeback
Thoroughbred
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tonkinese
Tosa Inu
Toucan
Toy Fox Terrier
Treeing Walker Coonhound
Turkey
Turkish Angora
Turkish Van
Turtle
Turtle
Vizsla
Warmblood
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
Date of Birth
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Coat Type
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Hairless
Short
Long
Medium
Colour
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Amber
Black
Black and Brindle
Black and Brown
Black and Tan
Black and White
Black, Brindle and White
Black Tabby
Black Tortie
Blue
Blue and White
Blue Merle
Blue roan
Blue Roan
Blue Tortie
Brindle
Brindle and Black
Brindle and White
Brown
Brown and Black
Brown and White
Calico
Chocolate
Chocolate and White
Chocolate Tortie
Cinnamon
Cinnamon Tortoiseshell
Cream
Cream Tortie
Cream & White
Dun
Fawn
Fawn and Black
Fawn and White
Fawn Tortoiseshell
Ginger
Ginger and White
Golden
Green
Grey
Grey and White
Grey Tabby
Grey Tortie
Harlequin
Harlequin and tan points
Lemon Tabby
Light Amber
Lilac
Lilac Tortie
Liver
Liver and White
Red
Red and Tan
Red roan
Red Roan
Ruby
Ruddy
Seal
Silver
Sorrel
Sorrel Tortoiseshell
Tabby
Tabby and White
Tan
Tan and Black
Tan and White
Tan Sable
Tortie
Tortie and White
Tricolour
Various
White
White and Black
White and Brindle
White and Brown
White and Cream
White and Grey
White and Liver
White and Tabby
White and Tan
White and Torti
White, Brown and Black
Yellow and Grey
Is your cat microchipped
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No
Yes
Microchip Number
Microchip Company
Is your cat Desexed
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No
Yes
Is your cat up to date on vaccinations
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No
Yes
Last Vaccination Date
Last Vaccination Type
Vet Name
Vet Contact Number
Vet Records can be supplied (Records required for all information above)
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No
Yes
Does your cat have any known health issues?
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No
Yes
Health issues
Where did you get your cat?
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Please Select
PAWS Darwin
RSPCA
ASPFM
TERG
DACS Inc
Backyard Breeder
Interstate Rescue
Family
Friend
Other
How long have you had your cat?
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Other please explain
Good with cats?
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yes
no
unknown
Good with dogs?
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yes
no
unknown
Good with Kids
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yes
no
unknown
Housetrained?
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yes
no
unknown
Has your cat ever killed or drawn blood on another animal?
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No
Yes
If yes above please supply details?
Has your cat ever attacked or drawn blood on a human?
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No
Yes
If yes above please supply details?
Any other behavior issues we should be aware of?
Has you cat been living:
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inside only
outside only
both inside & outside
Why are you choosing to surrender your cat?
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I require my cat to be rehomed prior to:
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Are you prepared to work with Paws so we can assist you with behavioural issue and help you try and keep your cat?
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No
Yes
I understand that a surrender fee is payable up to $400 dependant on the circumstances of the surrender and the condition of the cat.
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No
Yes
I understand that once accepted by Paws I will surrender all rights to my cat and Paws will have sole and exclusive right to make all outcome decisions and take all actions deemed appropriate including adoption or euthanasia. I will not be kept informed of any decisions made or actions taken.
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No
Yes
I understand a microchip transfer fee and FIV testing may incur further charges up to $25 each dependant on circumstances
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I understand a microchip transfer fee and FIV testing may incur further charges up to $25 each dependant on circumstances
No
Yes
I acknowledge that I am the legal owner of the surrendered animal and all information provided is true and accurate to the best of my knowledge.
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No
Yes
Signature of Applicant. Please use your finger on touch screen or click and hold your left button to use your mouse above the line.
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Please sign on screen or click and hold your left button to use your mouse.
Clear
Date
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Please enter your photographic identification
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Please up load a picture of the animal you are wanting to surrender
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Please upload Vaccination Records
Please upload Desex Certificate
Please upload Microchip Certificate