Greyhounds As Pets (Gap) Intake

GREYHOUND DETAILS

GREYHOUNDS AS PETS (GAP) INTAKE

GREYHOUND DETAILS

Greyhound’s kennel name
Greyhound’s registered name (if applicable)
Microchip no. (if applicable)
Ear brand(s) / Left: Right:
Sex / Colour
Whelping date / Weight

OWNER DETAILS

Name
I am the: /  Owner  Owner-trainer Other ______
OzChase ID
Street address
Telephone (home) / Mobile
Email

RECENT ACTIVITY

A greyhound requires a minimum let down period of 4 weeks prior to coming into Greyhounds As Pets (GAP), i.e. no racing, training or trialling. This will be confirmed via OzChase and dog will be refused entry into GAP if records show otherwise.)

Date of last race or trial
Greyhound’s current location
Name of greyhound’s current trainer

GREYHOUND HISTORY (attach additional pages as necessary)

Has this greyhound ever had marring issues?Provide details.
Injuries and treatment received
Other medical problems
Name of the worming product you give this greyhound
Date you last administered worming product
Date of greyhound’s last C5 vaccination

All Greyhounds coming into the GAP program must have an up-to-date C5 vaccination administered at least 7 days prior to coming into our care. Proof of vaccination must be attached to this form.

Dog / Bitch
Has the dog been desexed? / Has the bitch been desexed?
Have both testes descended? / When is the next season due?
Has either testicle been removed? / How many litters has she had?
What and how much do you feed your greyhound? Specify brand of dry food.

GREYHOUND TEMPERAMENT

Has this greyhound had any regular contact with children? If so, what ages?
How does this greyhound respond around children?
Has this greyhound had contact with dog breeds other than greyhounds? Provide details.
Does this greyhound have experience with cats? Provide details.
Has this greyhound ever snapped at, growled at or bitten a person? Provide details.
How would you describe this greyhound’s overall personality? Please tick all that apply:
very active / outgoing / very friendly / laid back / keen chaser / quiet in kennel
placid / shy / aloof / spooky/nervous / non-chaser / other? (please specify)

Note: Greyhounds found to be highly anxious or fearful are unlikely to be accepted into the GAP program. GAP staff will provide you with feedback if your greyhound does not pass the pre-assessment.

DETAILS PROVIDED TO ADOPTERS

If your greyhound is successfully rehomed, would you like your contact details passed on to the adopters?
If yes, provide the contact details you would like us to provide.

Please feel free to attach a letter, photos or anything else you would like to pass on to your greyhound’s new owners.

GREYHOUND FOUND UNSUITABLE FOR REHOMING
Note: If your greyhound is found to be unsuitable for rehoming within 7 days of passing its initial GAP pre-assessment, this greyhound will be returned to you and will remain your responsibility. By signing this form, you agree to re-accept custody of your greyhound if it is found to be unsuitable for rehoming during this period.
**If your greyhound is found unsuitable for rehoming at any point after these 7 days, would you like it returned to you?** *please circle one / YES / NO

DECLARATION, UNDERTAKINGS & AUTHORISATIONS

I declare that the particulars contained in this form are true and correct and that I understand it is a serious offence under the Greyhound Racing Rules and the Greyhound Racing Act 2009 to make a false declaration and / or provide false or misleading information at any time to GRNSW. I will advise GRNSW if there is any change in the particulars in this form. Failure to disclose full and accurate information to GRNSW when requested by GRNSW as part of its welfare, regulatory and supervisory activities may result in penalties and further action being taken by GRNSW or other relevant regulatory and law enforcement agencies.

PRIVACY POLICY

By signing this document you consent to us (Greyhound Racing New South Wales ABN 61 018 166 136, our related bodies corporate, affiliates and agents) collecting, using, holding and disclosing personal information about you. You can find out more about how we deal with your privacy by viewing our privacy policy at We may seek and obtain further personal information (including sensitive information) about you during the course of our dealings with you. The terms of this consent apply to the collection, use and disclosure of that information. If you do not provide us with this consent or provide us with your personal information we may not be able to provide services to you.

OWNER SIGNATURE / DATE / / /

Forward this form and a copy of the greyhound’s current (within the last 12 months) C5 vaccination certificate to GAP by post, fax or email. Please also ensure you have lodged a Consent Request form to GRNSW at ().

Greyhounds As Pets, PO Box 170, Concord West NSW 2138

Office: (02) 8767 0534 Free call: 1800 696 377 Fax: (02) 9764 6244 Email:

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