Intake

Pet Intake Application

Please complete this form if you need help rehoming your pet. Fields marked with an asterisk (*) must be completed.

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Owner’s details

Full name *

Date of birth *

You must be aged 18 or over to submit this application.

Address, including postcode *

Contact telephone number *

Email address *

Are you the animal’s legal owner or registered keeper? *

YesNo

If no, please provide the name and contact details of the legal owner or registered keeper and explain your relationship to them.

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Animal details

Species *
Please selectDogCatRabbitGuinea pigFerretOther

If you selected “Other”, please specify:

Animal’s name *

Animal’s date of birth or approximate age *

Sex *

MaleFemaleUnknown

Neutering status *

NeuteredNot neuteredUnknown

Was this animal born outside the UK? *

YesNoUnknown

If yes, where were they born?

Has this animal ever travelled outside the UK? *

YesNoUnknown

If yes, please tell us where they travelled and when.

Why do you need to rehome this animal? *

Please provide as much information as possible, including any relevant circumstances and timescales.

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Behaviour

Please answer each question as fully and honestly as possible. This information helps us understand your pet’s needs and assess how we may be able to help.

Please describe their behaviour around you and other members of your household. *

Please describe their behaviour around children. *

Please describe their behaviour around visitors and strangers. *

Please describe their general behaviour in the home. *

Please describe their behaviour around other animals, including cats, dogs, small animals and wildlife. *

If you could change anything about their behaviour, what would it be? *

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Medical information

Name of veterinary practice *

Veterinary practice address *

Veterinary practice telephone number *

Veterinary practice email address

Is your pet currently receiving any medication? If so, please provide the medication name, dosage and reason. *

Does your pet have any current or ongoing medical conditions? *

Are their vaccinations up to date, and when are their next boosters due? *

Are their flea and worm treatments up to date? Please tell us which products were used and when they were last given. *

For dogs only: have they ever been muzzled at a veterinary practice or groomer? If so, please explain why.

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Additional information

Is there any other information you feel we should know about your pet?

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Privacy and consent

I confirm that the information provided in this form is accurate to the best of my knowledge. I understand that Little Valley Animal Shelter will use this information to assess my intake request, contact me about my application and manage any resulting animal welfare case. I have read and agree to the Privacy Policy.

I would like to receive occasional news, appeals and updates from Little Valley Animal Shelter by email.

Marketing consent is optional. You can unsubscribe at any time, and your choice will not affect your intake application.

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Review and submit

Please check the information you have provided carefully before submitting your application.