Rescue Dog Adoption Application

(POTENTIAL ADOPTERS PLEASE NOTE THAT OUR SUGGESTED MINIMUM ADOPTION FEE HAS INCREASED TO £350 - WE REGRET THIS INCREASE WHICH IS DUE TO THE RISING OVERHEAD COSTS OF VETERINARY CARE AND TRANSPORT)

We ask that all adopters complete this questionnaire. The form is rather long and we apologise for this.
It is in no way meant to pry into your lives but it is to help us know that full consideration and thought has been taken prior to you adopting a Romanian rescue dog. Many have had traumatic experiences with people but we trust the Romanian rescuers that we work with to give us an honest description of the dogs we are hoping to help, so that we can best match them up with the homes offered.
Please answer truthfully. We aim to protect both you and the dogs from any unnecessary disruption or upset. Please also read our FAQ's page - Thank you.

Name of the dog if you are interested in a particular dog: *

First applicant name: *

Your age: *

Second applicant name:

Your age: *

Street Address: *

Town: *

City, County *

Home Phone: *

Area Code Phone Number

Work Phone:

Area Code Phone Number

First applicant Mobile Phone: *

Area Code Phone Number

Second applicant Mobile Phone:

Area Code Phone Number

E-mail: *

Character reference phone number: *

Are all members of your household in agreement with this adoption? *

Yes No Don't Know

How many adult live at this address? *

How many children live at this address? *

If children, what are their ages? *

Are there any visiting children? *

Have the children been around animals before? *

Yes No

Does anyone elderly or infirm live at the address? *

Does the applicant work? - If yes please state hours worked, full time, part time *

Who will be the pet's primary caregiver? *

Do you live in a *

House Flat Mobile Home

Do you own or rent? *

Own Rent

Does your landlord allow dogs? *

Yes No

Are there any restrictions from your landlord *

Number of pets Size or weight restrictions Breed restrictions None

Does anyone in your home have allergies to dogs or have asthma? *

Yes No

Please describe the location of the property (eg: rural, town etc) *

Is the home on a main road? If yes, please describe any security measures in place to ensure the dog’s safety *

Is the garden fully fenced on all sides? What height is this? Are there any gaps that would allow a small dog under/through? *

Is there a gate or other entrance? Is this secure? *

Do you own any dogs currently *

If yes, please give details breed, age, gender, neutered ? *

Are the above dogs socialised with other dogs? *

Do they display any issues when meeting other dogs on walks? *

Prior to the above, has the applicant/s owned any other dogs? (please give details, including breed, age, gender, whether deceased, rehomed etc) *

Have you adopted from an animal welfare group before? *

Yes No

If yes, what organisation? *

What experience, if any, do you have of behavioural issues ?i.e shy, timid, house training, destructiveness and how you overcame any such behaviours. *

How would you introduce a new dog to your home? *

Which rooms in the house will the dog have access to? *

How often and where will you walk the dog? *

Will bad weather have an impact on the frequency or length of the walks? *

Where will the dog go if you take a holiday? *

How might you help a dog adjust to a new home? *

Is it essential to you that a dog is house-trained? *

If a dog was not house-trained how would you manage this? *

What is the maximum length of time the dog would be left at home alone? *

If a dog was to be left for more than 4 hours, what provision do you have in place for this? *

Have you considered the additional cost of owning a dog? (food, toys, treats, dog-sitting/kennels, vaccinations, vet bills etc) *

Do you plan to take out insurance to cover veterinary bills?

Have you ever given up a pet? *

Yes No

If yes, what were the circumstances? *

Please provide the name and phone number of your current and/or previous veterinarian or clinic: *

Which rooms in the house will the dog have access to? *

How many hours each day will your new pet be home alone? *

Where will your new pet sleep at night? *

How will you supervise the dog's outdoor activity? *

Where will your new dog stay when nobody is home? *

What length of time will you allow your new pet to adjust to his new home? *

Are you willing to work through your new pet's issues, if any? *

Yes No

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *

Yes No

Do you plan to take an obedience class with your dog? *

Yes No Not sure

This adoption questionnaire is usually carried out in direct response to a specific dog application. Some applications are for a suitable dog coming into foster or a future rescue. If this is the case please complete the following:

Dog preferred

Male Female Either

Please indicate Age, Size and Type/Breed preferred

Please add any other information you feel would be helpful including any special requirements e.g. child / dog / cat friendly - low moult etc)

Please also note that a donation will be requested (minimum £350) for every dog – without these donations we would not be able to help another Romanian dog – Thank you

Please tick 'yes' in this box to confirm that all information given is to the best of your knowledge both true and honest *

Please tick YES

Please verify that you are human *

Rags to Riches Romanian Dog Rescue Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information