Simple Multiple File Upload

Contact Details:
Today's Date
Releasing owner's name
Address
Home Phone
Work Phone
Mobile
Email address

I unconditionally release the beagle described below to Beagle Rescue Victoria Inc. I declare that the information provided herein is true to the
best of my knowledge.

Beagle's Details:
Beagle's Name

Sex	Male	Female
Desexed	Yes	No
Colour	Tri	Lemon

Date of Birth (Age)
Weight

Please provide accurate dates for the latest vaccinations:

	C3	C5
	C4	Other

1. When did the beagle last have Flea / Worm / Heartworm medication?

Flea treatment
Worm treatment
Heartworm treatment

2. What type of Flea / Worm / Heartworm medication have you used?

Flea treatment
Worm treatment
Heartworm treatment

3. Do you have the receipts for the vaccinations?

Yes

If no, please provide the name of vet clinic where vaccines were given

4. Please attach below original paperwork of Desexing, Vaccination and Microshipping Certificates

Compress your files in a 'zip', 'jpg' or 'PDF' format. Max file size is 2MB.

NOTE: This form requires an attachment to work.
If you don't have original paperwork available, please attach a photo of your beagle.

Select File:

5. Please provide the details of your regular vet clinic:

Name
Address
Phone

6. Remarks to help us place your beagle (tick all that apply)

Well behaved?	Yes	No
Good with other dogs?	Yes	No
Good with cats?	Yes	No
Good with children?	Yes	No
leash trained?	Yes	No
House trained?	Yes	No	Sometimes

7. Other important things that we should know that will help us place him / her
in the most suitable home:

8. Reason(s) for releasing beagle:

BRV will contact you shorlty once we process this application.

Please click 'Submit' only once.

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