Owner/Agency Information Full Name Email Street Address City State---VICTASNSWACTSAWANTQLD Postcode Contact Number Pet Information Pet's Name Date of Birth Pet's Breed Pet's Sex---MaleFemaleDon't know Is your Pet Desexed?---YesNoDon't know Pet Insurance (veterinary care)?---YesNo Support required Veterinary care Describe the illness/injury: Name of Vet Quote ($) I provide BAWCS with authority to speak with the treating vet(s) or associated personnel about my pets needs and associated finances.---YesNo Pet Accommodation: tick which applies Domestic violence support emergencyEntry into Rehabilitation ProgramTemporary homelessnessOther Please specify: Pound reclaim: Cost ($) Outreach visits/ pet supplies: (please detail number of pets and if supplies will be required) Dog training (instead of surrender). Please advise the issues you are having with your dog. Need: Pension / Disadvantage BAWCS assists pet owners in 'necessitous circumstances' and the ATO require knowledge relating to the following: What type of pension are you on? Other extenuating circumstances, mental health, children, etc Social: Marital status---MarriedDe-factoSingle Accommodation---RentingMortgagedOwner Financial: How reliant are you on your Centrelink pension? i.e. Do you have any other financial income? What steps have you taken to pay for your pets required care? How much can you afford to contribute? ($) Δ
