Rental Pet Request: When your pet needs a home

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Animal Type*

Breed Details*

Name of pet*

Colour*

Age*

Please enter a number from 0 to 50.

Weight*

kgs

Desexed or Registered Breeder*

If the animal is desexed we will require a certificate, if not yet desexed we will require a month in which you will have the procedure completed & if you are planning on breeding you will need to be a registered breeder and provide evidence accordingly

Vaccination Certificate*

If 'Yes' please provide a copy of the Vaccination Certificate. If 'No' please provide an explanation

Microchip Certificate*

Available from the national database or your vet

Vet Name*

Vet Address*

Vet Phone Number*

Registration Required*

State or National?

Pet Insurance*

A brief summary of where the pet will spend the day/night*

Emergency Pet Carer Details (not owner's details)*

First Last

Emergency Pet Carer Number (not owner's details)*

Consent*

I acknowledge that my pet application has been submitted during a holiday shut down period and the 14 day submission period will not start until 11th January 2021 when the Civium office resumes normal office hours

Rental Pet Request

Simply fill out the Rental Pet Request form and we will do the rest

Rental Pet Request

Talk to Civium