Emergency Pet Care - Intake Form

Owner agreement to place pet(s) into short term kennel boarding with one of our support partners or in-home foster care, if available. Please provide as much information as possible to ensure a positive experience for both you and the animal(s).

To promote responsible pet ownership, ALL pets entering our programs must be:

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

Vaccinated (to prevent serious illnesses such as Parvovirus, Cat Flu, and Feline Enteritis) - if not already vaccinated, this must be done BEFORE entering our bording program as it is a requirement of our kenelling partners.

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

Stay will arrange for these mandatory services to be carried out on your behalf. Please note that there will be a non refundable contribution fee payable for these vet services.

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.Format: (000) 000-0000.

Owner's Emergency contact/relationship to Owner:*

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

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?*

Domestic violenceHomelessnessRespite/hospital admissionMedical illness

How long does your pet require emergency care for?*

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 and discharge 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/foster care*

YesNo

The Stay Foundation will provide up to two weeks kennel boarding with one of our partners, however we do require a non refundable contribution to be paid. Are you able to pay a contribution towards their stay?*

YesNo

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

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 your pet is not already desexed, this will be arranged once they enter our care, as desexing is a mandatory requirement of our program. By signing this form, you are providing consent for your pet to be desexed while in our care.

It is also a mandatory requirment of our program, as well as a non negotiable requirement of our kennelling partners, that your pet is also up to date with all vaccinations as well as microchipped and registered with your local Council.

If not already done, this will be done whilst your pet is in our care and/or before they enter kennelling.

If your pet is female and they are not desexed are they on heat?*

YesNoN/A

If no, what date was their last heat?

If your pet is male, have both testes descended?*

YesNoN/A

If your pet is undergoing desexing surgery, have they been well over the last 14 days?*

YesNoN/A

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?*

YesNoN/A

Is your pet microchipped?*

YesNo

Microchip number:

Is the microchip in your name?*

YesNo

Is the pet registered in your name?*

YesNo

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

Is your pet registered with a Local Council?*

YesNo

What Council is your pet registered in?

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

Are your pet's monthly preventative tick, flea, worm etc up to date?*

YesNo

Is your pet currently taking any medications? If yes what type?

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?*

Is your pet accustomed to children? Have they 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?*

If you have a dog, is the dog well behaved on a leash walking in public?*

How many hours a day are your pets accustomed to having company?*

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/foster stay, your pet will be returned to your care and that you have suitable accommodation?*

YesNo

By signing this application, I acknowledge and agree to the following:

1. I confirm that I am over 18 years of age, the legal owner of the pet listed above, and that all information provided is true and accurate to the best of my knowledge.

2. 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.

3. 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.

4. I understand that The Stay Foundation reserves the right to cancel or postpone any procedure at its discretion and without prior notice.

5. I give consent to the Stay Foundation and its veterinary partners to provide vet care to my pet including desexing, vaccination and microchipping.

6. I acknowledge the risks associated with anaesthesia and surgical procedures. I understand that only a basic pre-anaesthetic evaluation (excluding blood tests) will be performed and accept the risks associated with any undetected underlying conditions.

7. I accept that The Stay Foundation covers only the procedure listed in this application and is not liable for any complications (including death or permanent injury) or associated costs that may arise during or after surgery.

8. I understand that any medical conditions identified during examination or surgery will be communicated upon discharge, and that no additional treatments will be provided under this program. Any further treatment required is my sole responsibility.

9. I agree to cover any costs not explicitly approved in writing by The Stay Foundation.

10. I accept full responsibility for providing appropriate post-operative care, including adequate food, water, shelter, and monitoring of my pet during recovery.

11. I understand that failure to follow the post-operative care instructions may result in complications for which The Stay Foundation is not responsible, financially or otherwise.

12. I agree to release, indemnify, and hold harmless The Stay Foundation, its staff, veterinarians, and volunteers from any and all claims, damages, injuries (including death), or losses arising from or connected to the services provided.

13. I hereby authorise the veterinarian engaged by The Stay Foundation to perform the procedure listed and consent to treatment as described under the terms of this waiver.

I have read, understood, and agree to the terms outlined above.

Did you require assistance in completing this form*

YesNo

If yes, please provide the name of the 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.