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Test

Expression of Interest - Online Adoption Form

Form for prospective adopter to complete to register interest in an available cat or dog.

Date
MM slash DD slash YYYY
What type of animal are you enquiring about?*
- Cat/Kitten
- Dog/Puppy
Cat/Kitten of Interest*
Dog/Puppy of Interest*
Where did you first hear of this cat/dog?*
Please quote the reference number if applicable.
Reason for adopting*
- Family companion
- For my children
- Gift for someone
- Hunting/mouser/guard
Your Name*
First Last
Your Address*
Street Address Address Line 2 City/Suburb State Postcode Country
Home Phone*
Mobile Phone
Email
Alternate Contact Person for the Animal
(In the event of an emergency and owner cannot be reached)
Name*
First Last
Phone*
Intended Payment Method
- Cash
- Eftpos
- Credit Card
Please mark all that apply
Your home
- House
- Townhouse
- Apartment/Unit
- Caravan
- Acreage
Who owns your home?*
- Landlord
- Me
- Live with parents/friends
Since you do not own your residence, we need to ensure you have the owner's permission to have a pet on the premises.

Please provide the landlord's phone number or email address, or upload a copy of the home owner/landlord's letter of approval to have pets living on the premises.
Since you own your residence, we need to confirm your status as the home owner.

Please upload a copy of your latest rates notice or utility bill.
Landlord or Owner's Contact details*

Landlord or owner's email and/or phone number
File
Max. file size: 512 MB.
Home Lifestyle*
- Active
- Calm/Quiet
Experience owning a cat(s)*
- First time cat owner
- Have had 1 or 2 cats
- Have had many cats
Experience owning a dog(s)*
- First time dog owner
- Have had 1 or 2 dogs
- Have had many dogs
Pet will be housed*
- Inside
- Outside
- Both
Children and Your Home*
- I have children
- I do not have children
- Children visit my home
- No children visit my home
Ages of children*
Reason for adopting*
- Family companion
- For my children
- Gift for someone
- Hunting/mouser
- Companion for other pet
Time spent away from home*
- Home all day
- Out part time
- Away 7-10 hours per day
Have you ever surrendered a pet before?*
- Yes
- No
Do you have or have you had pets in the past?*
- Yes
- No
PETS LIVING WITH YOU - PAST & PRESENT Please list all pets you've owned in the past 10 years
Type of pet*
- Cat
- Dog
Pet's Name*
Pet's Age*
Pet's Sex*
- Female
- Male
Pet's Breed/Type*
Was this pet desexed?*
- Yes
- No
- Not sure
How long did you own this pet?*
Is this pet currently residing with you?*
- Yes
- No
Do you have or have you had any other pets in the past?*
- Yes
- No
Type of pet*
- Cat
- Dog
Pet's Name*
Pet's Age*
Pet's Sex*
- Female
- Male
Pet's Breed/Type*
Was this pet desexed?*
- Yes
- No
- Not sure
How long did you own this pet?*
Is this pet currently residing with you?*
- Yes
- No
Do you have or have you had any other pets in the past?*
- Yes
- No
Type of pet*
- Cat
- Dog
Pet's Name*
Pet's Age*
Pet's Sex*
- Female
- Male
Pet's Breed/Type*
Was this pet desexed?*
- Yes
- No
- Not sure
Pet's Age*
How long did you own this pet?
Is this pet currently residing with you?*
- Yes
- No
Do you have or have you had any other pets in the past?*
- Yes
- No
Type of pet*
- Cat
- Dog
Pet's Name*
Pet's Age*
Pet's Sex*
- Female
- Male
Pet's Breed/Type*
Was this pet desexed?*
- Yes
- No
- Not sure
How long did you own this pet?*
Is this pet currently residing with you?*
- Yes
- No

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