Owner/Agency Information Full Name Email Street Address City State---VICTASNSWACTSAWANTQLD Postcode Contact Number Pet Information Name Age Breed 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: I live week-to-week reliant on a Centrelink pension---YesNo What steps have you taken to pay for your pets required care? How much can you afford to contribute? ($)
