Dog Surrender Application

Owner First Name *
Owner Surname *
Street Address *
City *
State *
Post Code *
Phone Number *
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) *
Animal Name *
Gender *
Breed *
Date of Birth *
Size *
Colour *
Is your dog microchipped *
Microchip Number
Microchip Company
Is your dog Desexed *
Is your dog up to date on vaccinations *
Last Vaccination Date
Last Vaccination Type
Vet Name
Vet Contact Number
Vet Records can be supplied (Records required for all information above) *
Does your dog have any known health issues? *
Health issues
Other - Please explain
Where did you get your dog? *
How long have you had your dog? *
Good with cats? *
Good with dogs? *
Good with Kids *
Housetrained? *
Has your dog ever killed or drawn blood on another animal? *
If yes above please supply details?
Has your dog ever attacked or drawn blood on a human? *
If yes above please supply details?
Does your dog have any of the following issues: *
Any other issues we should be aware of?
Why are you choosing to surrender your dog? *
I require my dog to be rehomed prior to *
Are you prepared to come to training so we can assist you with behavioural issue and help you try and keep your dog? *
I agree that I will bring my dog to a Paws Training Session so a temperament assessment can be conducted prior to acceptance *
I understand a Microchip transfer fee of $25 may be applied if applicable *
I understand that a surrender fee is payable upto $400 dependant on the circumstances * Answering no to this question means we will not accept your application.
I understand that once accepted by Paws I will surrender all rights to my dog 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. *
I acknowledge that I am the legal owner of the animal above and all information provided is true and accurate to the best of my knowledge. *
Signature of Applicant. Please use your finger on touch screen or click and hold your left button to use your mouse above the line. * Please sign on screen or click and hold your left button to use your mouse.
Date *
Please enter your photographic identification *
Please attach a copy of your desexing certificate
Please attach a copy of your Microchip Certificate
Please attach a copy of you Vaccination Records