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Before starting this form, if the dog is microchipped, please ensure you have the microchip details to hand.
Microchipped animals can only be surrendered by the registered owner and this must be verified before the surrender appointment can be booked in.
Your details
If you wish to surrender more than 1 dog, please fill in one form per dog.
Name
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Title
First name
Last name
Phone number
*
After your dog has been surrendered to the RSPCA, there may be occasions where we may try to contact you for more information on your dog’s behaviour or medical background. Will you be contactable after the surrender has occurred?
*
Please select
Yes
No
What days are you available for us to call you?
*
Our dog behaviour team will phone you from a private number to discuss your dog and arrange a surrender appointment time. Please select all days that work for you.
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays
Email address
*
Current address
*
Street
Suburb
Postcode
Which RSPCA South Australia shelter is closest to you?
*
Please select one
RSPCA Lonsdale
RSPCA Port Lincoln
RSPCA Whyalla
Please note that whilst surrender fees apply, our staff are considerate and understanding to individual financial situations and can discuss options with you
• Dogs/puppies- $75 & different price for multiple • Cats/kittens- $60 & different price for multiple • Rabbits- $60 & different price for multiple • Reptiles- $20 & different price for multiple • Other small pets- $20 & different price for multiple •
Your dog's details
Please provide as much detail as possible in the questionnaire, this allows us to determine the most suitable home for your dog to be rehomed to. We aim to be in contact within 2 weeks of submitting your application. Please be aware we may phone from a private number.
Dog's name
*
Dog's Date of Birth (if known)
Does not need to be exact, but as close to as possible.
DD slash MM slash YYYY
Age
*
Breed
*
Gender
*
Please select one
Female
Male
Colour(s)
Please upload a clear photo of your dog (if possible)
This photo may be used on their adoption profile
Drop files here or
Select files
Accepted file types: jpg, jpeg, jpe, gif, png, bmp, , Max. file size: 10 MB, Max. files: 3.
Is the dog spayed/neutered?
*
Please select one
Yes
No
Unsure
Is the dog microchipped?
*
Providing your microchip is important as it allows us to start processing your dog prior to their arrival at the shelter.
Please select one
Yes
No
Unsure
To avoid delays in surrendering your dog, we strongly advise that you speak with a vet about having them scanned for a microchip as we cannot accept an animal for surrender from anyone other than the registered owner.We recommend resolving this prior to completing the surrender form, to ensure the process can be completed as smoothly and quickly as possible.
If yes, what is the microchip number?
Is the dog microchipped to you?
RSPCA SA can only accept surrenders from the microchipped owner. (When microchipped) Please go to www.petaddress.com.au and enter your dogs microchip number to find out what registry the microchip is registered to. Follow the link to the website to change ownership if required.
Yes
No
Unsure
I understand I am required to change the microchip details in to my name prior to surrender.
Yes
No
Is the dog registered with a council?
*
Council registration is done via Dogs and Cats Online (DACO)
Please select one
Yes
No
Unsure
If yes, which council?
Does your dog have any of the following control orders put on them through council?
*
Please select one
None
Barking
Nuisance
Menacing
Dangerous
Which council issued this order?
*
If your dog is subject to any orders can you please provide details as to why they have been issued with this order and what is required in the order?
*
Where did you get your dog?
*
Please select
Shelter
Breeder
Gumtree/Facebook
Private Sale
Friend/Family
Rescue
Other
If you answered Rescue, which one?
*
If you answered other, please specify
*
How old was the dog when you acquired him/her?
*
Are you surrendering the dog because you can't afford vet treatment?
*
Please select one
Yes
No
If no, why are you surrendering the dog?
*
We make no judgment, but this info helps us a lot.
We’d love to be able to work with you to help you to keep your dog at home. If you feel the same way, we can arrange for our behaviour team to contact you to provide advice and guidance around any behavioural issues, so that your dog doesn’t have to come to us.
Is this something that would interest you?
*
Yes
No
If yes, what treatment is needed?
Have you attempted to rehome your dog through any of the following;
No
Animal Welfare League
Breeder
Private Sale
Friend/Family
Gumtree/Facebook
Rescue
Other
If you answered Rescue, which one?
*
If you answered other, please specify
*
If so, what was the reason this did not work out?
Would you be open to keeping the dog in your home until we can find a suitable match?
*
Yes
No
Describe your favourite thing about your dog:
What behaviours/characteristics/habits are you not fond of in your dog?
What sort of home and family do you believe would suit your dog? (eg, adults only, quiet, home a lot, females only, no other animals)
Please complete the microchip information to continue
Health and vaccinations
When did your dog last visit a vet?
*
Please Select
Within the last 6 months
Within the last 12 month
Within the last 2 years
Not since a puppy
Never
What is the name of your current vet and any vet you have seen in the past?
This will enable us to obtain any medical history about your dog that is required to assist with rehoming. Please give clinic name and phone number if possible.
Has your dog ever had any vaccinations?
*
Yes
No
Unsure
If yes, when was the last vaccination?
Please upload a copy of your dog's most recent vaccination certificate.
This document is crucial in helping us determine whether or not your dog might need quarantining.
Drop files here or
Select files
Max. file size: 100 MB.
Does your dog have any signs of illness/injury that concern you?
*
Yes
No
If yes, what are the signs? Please provide as much detail as possible:
Does your pet have, or has ever been diagnosed (by a vet) with a medical condition (include any anxiety related issues)?
*
Yes
No
If yes, please provide details:
Is your dog on any medication (if yes, please bring this medication in when you surrender your dog)?
*
Yes
No
If yes, please provide details:
*
(include behaviour medications such as fluoxetine, trazodone, gabapentin, etc.
How does your dog behave at the vet? (e.g. friendly, scared, tries to bite, etc.)
*
Lifestyle
Where is your dog allowed in the home?
*
Please select one
Outside
Inside
Both
Where does your dog prefer to spend most of its time?
*
Please select one
Indoors
Outdoors
Is your dog allowed on furniture?
*
Please select
Yes
No
Where does your dog sleep day and/or night?
*
You can select multiple options.
Indoors – in own bed
Indoors – on owners bed
Indoors – in a crate
Indoors – in laundry/other room
Outdoors – in bed
Outdoors – in kennel/dog run
How would you describe your dog’s toilet training?
*
Please select
Great, has no accidents
OK, only rare accidents (less than once a month)
Could be better, a few accidents each week
Awful – accidents nearly every day
If you are having issues with toilet training, how long has this problem been going on?
How have you tried to address this problem? Did anything you tried help the problem?
When no one is home, where is your dog kept?
*
Indoors
Outdoors
Access to both
Does your dog use a dog door/flap?
Yes
No
How long is your dog left alone without people on an average day?
*
Please select
9am - 5pm (School/business hours)
>12 hours a day
Short Periods - less than a few hours at a time
Never, owners always home
When your dog is left alone, select which best describes their behaviour?
*
Please select
No issues, settles quickly
Barks/Cry/Howls for a short time then is able to settle
Barks/Cries/Howls all day
Destroys structural items such as doors/walls
Destroys furniture or smaller items (including toys)
Tries to escape
Other
If other, please provide more information
If you are having issues with your dog being left alone, how have you tried to address this problem (eg, keeping dog inside when alone, providing extra toys, bones)? Did anything you try help?
Has your dog ever escaped or tried to escape?
*
Please select one
Yes
No
If yes, how long ago did the escaping attempts start?
The moment escaping starts can often relate to a time of change in your dog's life, which is important information for our behaviourists.
If yes, how did your dog escape or try to escape?
Please select all that apply.
Jumped fence
Climbed fence
Dug under fence
Broke through fencing
Other
If other, please provide more information
If yes, how often has your dog escaped or tried to escape?
Please select all that apply.
Daily - when no one is home
Daily - Even when someone is home
Weekly
Monthly
Only ever escaped once or twice
Only during storms/bad weather
How have you tried to address this problem (eg, Keeping inside, extending fences)? Did anything you try help?
How high are your fences and what are they made of?
Please select all that apply.
4 feet
6 feet
Higher than 6 feet
Chain mesh or wire
Colourbond
Brick
Does your dog bark at or chase other dogs or people along the fence line?
*
Yes
No
Does your dog vocalise excessively?
*
Yes
No
If yes, have your neighbours ever complained about the vocalising?
*
Yes
No
Third Choice
If yes, has council been involved about the barking complaints?
*
Yes
No
If yes, please select the option that’s most relevant to your dog:
*
All day and night for no apparent reason
Only when there is someone/something to bark at (e.g. postman, strangers, dog walking past)
When people come to the house
Other
If other, please provide details;
Home Life
How would you describe your household?
*
Quiet (e.g. Not many visitors, no younger children)
Busy (e.g. Lots of visitors regularly, young children playing at home)
In between
Does your dog live with;
*
You can select more than one
Adult Men
Adult Women
Teenagers (13-17)
Children (7-12)
Children (3-6)
Children (1-2)
Infant
Does your dog have free access to everyone who lives in the household?
*
Yes
No
If no, why are they kept separate/restrained?
How did you dog interact with everyone? (e.g. friendly, scared, boisterous) Please provide as much detail as possible:
*
Does your dog live with, or have they ever lived with another dog or other animal at home?
*
Yes
No
If yes, please provide details of other animals: (please include species, name, breed, gender and if they are desexed, who came into the home first)
Does your dog interact with all the other animals in the home, or are they kept separate? If so, why? (Please provide details)
If your dog lives with another dog, how do they go when they are separated from each other ?
Social interactions - Humans
Has your dog met or been exposed to many (tick all that apply)
You can select multiple answers
Unfamiliar Men
Unfamiliar Women
Unfamiliar Children
People in high-vis/bright clothing
When interacting with men, please select the best options that applies to your dog:
*
Enjoys their company and will solicit interactions/plays with them appropriately
Tolerates being near them and being touched by them, but prefers space and will move away when uncomfortable
Becomes overexcited/stressed, barks, will jump/scratch/mouth/nip them
Fearful, avoids them as much as possible
Barks aggressively/growls/attacks
Please describe in as much detail possible any unpleasant situations that have occurred with familiar or unfamiliar men:
When interacting with women, please select the best options that applies to your dog:
*
Enjoys their company and will solicit interactions/plays with them appropriately
Tolerates being near them and being touched by them, but prefers space and will move away when uncomfortable
Becomes overexcited/stressed, barks, will jump/scratch/mouth/nip them
Fearful, avoids them as much as possible
Barks aggressively/growls/attacks
Please describe in as much detail possible any unpleasant situations that have occurred with familiar or unfamiliar women:
When interacting with children, please select the best options that applies to your dog:
*
Enjoys their company and will solicit interactions/plays with them appropriately
Tolerates being near them and being touched by them, but prefers space and will move away when uncomfortable
Becomes overexcited/stressed, barks, will jump/scratch/mouth/nip them
Fearful, avoids them as much as possible
Barks aggressively/growls/attacks
Please describe in as much detail possible any unpleasant situations that have occurred with familiar or unfamiliar children:
Has your dog ever bitten anyone?
*
Yes
No
If yes, did the bite leave a puncture wound or draw blood?
*
Yes
No
Third Choice
Please describe the incident(s) in as much detail as possible (e.g. where did the incident occur, what was happening at the time, where was the person bitten, was there any medical treatment required, how long ago did this occur, dogs reaction after bite)
*
Do you need to physically restrain your dog or keep them separate when visitors or strangers come to the house?
*
No
Yes – for visitors safety (dog may bite)
Yes – dog gets too excited, likely to jump/scratch the visitor
Yes – dog does not interact with visitors by owners choice
Are there any body parts that your dog doesn’t like being touched?
*
Yes
No
If yes, what parts of the body and what do they do?
*
Social Interactions - Animals
How does your dog react when they see another dog outside of the home?
*
Friendly
Barks but friendly
Wants to play
Barks/Growls
Tries to attack
Not interested or avoids
Doesn’t leave the property
How does your dog react if another dog comes to their house?
*
Friendly
Barks but friendly
Wants to play
Barks/Growls
Tries to attack
Not interested or avoids
Never been in that situation
When was the last time your dog interacted with another dog (not including dogs they live with)?
*
Within the last 6 months
Within the last 12 month
Within the last 2 years
Not since a puppy
Never
Approximately how many dogs does your dog interact with per month?
*
1-2
Less than 5
Less than 10
More than 10+
Never socialises
Does your dog play with other dogs off lead?
*
Yes
No
Does your dog interact differently with other dogs depending on if they are on lead or off lead?
*
Yes
No
If yes, please describe in as much detail as possible:
Does your dog behave differently around dogs that are larger or smaller than them? (e.g. my dog is good with dogs of the same size or larger, but snaps at smaller dogs)
Has your dog had a fight with another dog?
*
Yes
No
If yes, please provide as much detail as possible on the incident/s:
(e.g. where did the fight occur, were the dogs known to each other, what caused the fight, how old was your dog at the time, were there any injuries, what veterinary treatment was required, how did you get the dogs to stop fighting)
Please describe in as much detail as possible of any unpleasant interactions your dog has had with familiar or unfamiliar dogs
(e.g. my dog growls at small dogs only, gets scared, runs away)
How does your dog interact with cats?
*
Friendly
Not Friendly
Not Interested
Don't Know
Please describe in as much detail as possible any unpleasant interactions your dog has had with familiar or unfamiliar cats
(e.g. stray/known cat, where did the incident occur, were there any injuries)
How does your dog interact with medium-large animals? (e.g. kangaroos, sheep, pigs, goats, cows, horses, alpacas etc.)
*
Friendly
Not Friendly
Not Interested
Don't Know
Please describe in as much detail as possible any interactions with medium-large animals
(please include species, if they are friendly, if they chase, if they try to attack and if there were injuries)
How does your dog interact with small animals? (e.g. poultry, guinea pigs, rabbits, possums, lizards, wild or domestic birds)
*
Friendly
Not Friendly
Not Interested
Don't Know
Please describe in as much detail as possible any interactions with small animals
(please include species, if they are friendly, if they chase, if they try to attack and if there were injuries)
General Behaviour
How often do you walk your dog?
*
Daily
Weekly
Monthly
Never
What walking equipment do you use when going for a walk?
Flat Collar
Head Halter
Body Harness
Choker Chain
None/Walks without a lead
Where do you walk your dog? (please select all that apply)
Beach
Dog Park
Streets/Suburbs
Walking Trails
How does your dog behave when being brushed or bathed?
*
Compliant
Fusses but can control
Scared
Panics and cannot control
Becomes aggressive
Never tried
Has your dog ever been professionally groomed?
*
Please select one
Yes
No
Can you easily trim your dog's claws?
*
Please select one
Yes
No
Never tried
What are your dog’s favourite toys?
What do you feed your dog? At what times of the day are they fed?
*
Does your dog have any favourite treats?
Does your dog travel well in the car?
*
Yes
No
If no, what does your dog do?
How do you get your dog in the car?
Jumps in by themselves
Have to lift into the car due to age, size or injury
Tries to get in on their own but needs some assistance
Refuses to get in, have to force into car
How often does your dog travel in the car?
Daily
Weekly
Monthly
Rarely
Never
Is there anything that causes your dog to become nervous or fearful? If yes, how does your dog react?
*
e.g. storms, fireworks, loud noises, camera flashes, vacuum cleaner, lawn mower
Does your dog obsessively or repetitively chase their tail, lights or shadows?
*
Yes
No
If yes, please provide as much detail as possible about the behaviour:
(e.g. what triggers this to occur, how often does it happen, how long does it last, is it easy to distract your dog when they are doing this)
Do you muzzle your dog in any of the following situations?
*
Never
Around other dogs
Around other people
When you leave the house
At the vet
Other
Please provide more details (Why, how often, what lead you to decide to do this?)
*
Is your dog comfortable with people being around when they are being fed?
*
Please select one
Yes
No
Don't Know
If no, what do they do in that situation?
(e.g. growls, snarls, show whites of eyes, lunges, snaps, attacks)
Is your dog comfortable with other dogs or animals being around when they are being fed?
*
Please select one
Yes
No
Never tried
If no, what do they do in that situation?
(e.g. growls, snarls, show whites of eyes, lunges, snaps, attacks)
Can you easily take food, bones and/or toys from your dog?
*
Please select one
Yes
No
Never tried
If no, what do they do in that situation?
(e.g. growls, snarls, show whites of eyes, lunges, snaps, attacks)
Training
Has your dog attended training or puppy classes?
*
Please select one
Yes
No
If yes, what type of classes (eg, puppy, level 1), how long ago and what was the name of the training/school you went to?
What type of training methods have you used for your dog?
Dominance/Pack Leader
Punishment
Positive Reinforcement/Reward based
Both punishment and reward based
Clicker training
None
What cues and commands does your dog respond to?
Sit
Stay
Leave It
Shake
Wait
Come
Drop
Heel
Watch
Other
If other, please specify
Does your dog come when called?
*
Please select one
Yes
No
Sometimes
How well does your dog walk when on a leash?
*
Please select one
Walks well
Pulls sometimes
Not well - pulls constantly
Won't walk
Final details
Is there anything else you would like to tell us about your dog?
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
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