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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
Date Format: 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
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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