Owner Intake Form - Short Term Kennel Boarding (Subsidised Rate)

Owner agreement to place pet(s) into short term boarding with one of our support partners. As an owner of a pet to be placed into emergency boarding for a short term, we need this application completed and for you to add any other information that may be of help to ensure a positive experience for both you and the animal(s).

To promote responsible pet ownership, ALL pets entering our programs must be:
Vaccinated (to prevent serious illnesses such as Parvovirus, Cat Flu, and Feline Enteritis) - if not already vaccinated, this must be done BEFORE entering our program.

Microchipped and registered (a legal requirement in New South Wales and essential for pet reunification) - if not already microchipped, this can be done while in our care.

Desexed (reducing health risks and preventing unwanted litters) - if not already desexed, this can be done while in our care.

Stay will arrange for these mandatory services to be carried out on your behalf. If these services are required, they must be selected in the Vet Care/Desexing Application and Consent Form and the non refundable deposit paid for EACH service requested unless there is a serious medical reason preventing them.

Overview of situation*

Referring agency and contact details including caseworker's name, phone number and email*

Owner's Name*

First NameLast Name

Owner's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Owner's Emergency contact/relationship to Owner:*

Phone Number*

Please enter a valid phone number.

Please provide proof of residence and identification by uploading a copy of your Driver's License or proof of residence such as a copy of a household service bill , phone bill, council rates (in your name at your current address) etc*

Are you a Housing NSW Resident?*

YesNo

Are you currently on a pension or receiving Centrelink benefits?*

YesNo

Please upload a copy of your Pension card or proof of receipt of Centrelink benefits

Why are you seeking care for your pets?*

If care for your pet is required for respite/hospital care, please upload a copy of your admission confirmation letter from the hospital showing all admission dates

Can your pet(s) photo be shared publicly on our social media and for advertising purposes? Please note names will be changed to protect privacy.*

YesNo

Can you transport your pet(s) to and from the kennels*

YesNo

I would like to pay a contribution to The Stay Foundation to go towards the costs of my pet(s)' kennel boarding fees*

YesNo

My Contribution

AUDDonation contribution

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Pet's name*

Type of pet*

DogCat

Sex*

MaleFemale

Age of pet/DOB*

Weight of pet if known

Breed*

Colour of pet*

Contact details of your pet's usual veterinarian

All pets that enter our boarding program must be vaccinated, microchipped, and desexed, unless a medical reason prevents it. This is a non-negotiable condition of the program. An unvaccinated, entire pet can still be placed in boarding, but they will be vaccinated and desexed once in our care.

If your pet requires vet work whilst in care, you will need to complete and lodge a Vet Care Application for Pets in Foster Care/Kennel Boarding before your pet will be able to enter our program.

Is your pet desexed?*

YesNo

If your pet is desexed, please upload a copy of their desexing certificate or details of the vet who performed the desexing.

Details of vet who performed desexing

If No, are you willing to have your pet desexed?

YesNo

If No, reason why:

Is your pet vaccinated? If so which one? Dog C5, C3. Cat F3, F4*

Please upload a copy of the last vaccination certificate or provide details of the vet who administered the vaccination

Details of the vet that provided the vaccination.

If you have a cat coming into care, is it FIV positive?*

YesNo

Is your pet microchipped?*

YesNo

Microchip number:

Is the microchip in your name?*

YesNo

If you have a dog coming into care, is the dog registered?*

YesNo

Is the dog registered in your name?*

YesNo

If not, who's name is the dog registered in?

What Council is the dog registered in?

If you have a dog coming into care, is there a current dangerous dog order or has there been?*

Is your pet toilet trained?*

YesNo

What does your pet usually eat?*

What treats does your pet like?*

Has any food caused problems?*

Does your pet have food aggression?*

Where does your pet usually sleep?*

Have you ever had your pet/s in care before? If so where?*

Can you give us any more information that would be helpful in caring for your pet? *

Does your pet have any behavioral issues? Destructive? Dig holes? Barks or howls? Escapes from the yard? If yes please describe:*

Does your pet usually live in a house, apartment, unit, rural or other?*

Has your pet ever been aggressive towards children or people in general?*

Does your pet relate well and friendly with other animals? What animals have they lived with before?*

The Stay Foundation's mission is to ensure that families and their pets STAY together. Do you confirm that, at the conclusion of your pet's agreed kennel stay, your pet will be returned to your care and that you have suitable accommodation?*

YesNo

I agree by signing this document. I hereby indemnify The Stay Foundation Limited, its staff, volunteers and all agents against all actions, court proceedings, claims, demands for damages compensation, cost, or otherwise arising out of or in respect of The Stay Foundation Limited providing emergency accommodation, including any vet care given.
In consideration of The Stay Foundation Limited providing such emergency accommodation, I agree that I will not make any claim or demand against The Stay Foundation or any of its staff, volunteers or agents, for anything arising out of or in connection with The Stay Foundation Limited providing such emergency accommodation for my animals.

Did you require assistance to complete this form?*

YesNo

If yes, please provide the name of person who assisted you in completing this form and their relationship to you

Signature*

Date*

Date

We will be in touch as soon as possible via email to advise of next steps. Please ensure you check your spam/junk email folders if you have not received a response.