ADOPTION APPLICATION
Please fill out truthfully and accurately.
YOUR DETAILS
Name
*
First Name
Last Name
Date of birth
*
-
Day
-
Month
Year
Date
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Where do you work?
Personal reference: name (not a family member that you are happy for us to call if needed), relationship, and phone number.
Are you a New Zealand citizen
Yes
No
We are working on it
DETAILS OF DOG
If there is not a specific dog you are interested in leave this blank.
Name
Breed
Age
Sex
Male
Female
Why are you interested in this dog?
YOUR PROPERTY
Do you own or rent?
*
Own
Rent
If you rent, do you have permission from your landlord to have a dog?
Yes
No
Landlord's name
First Name
Last Name
Landlord's email
example@example.com
Landlord's phone number
-
Area Code
Phone Number
Please describe you section, including size and fence: e.g. material, height at lowest point
OTHERS THAT LIVE AT YOUR HOUSE
Names of people that live at your house?
Please include ages, experience with dogs, if they are comfortable around dogs.
Names of Animals that live at your house?
Please include type, breed, age, if they are desexed, vaccinated, flead and wormed, microchipped, registered, and if they are ok with dogs.
Past dogs that you have had?
Please include breed, age, if you rehomed them (if yes say why).
LOOKING AFTER THE DOG
Where will the dog sleep?
*
On a typical day, how long will the dog be left alone?
*
Where will the dog be while you are away from the house?
*
Can you afford to keep vaccinations, registration, flea and worm treatment up to date?
*
Yes
No
If anything unexpected happened to the dog (medical or behavioural) how would you deal with this? Can you afford to cover this?
*
If you unexpectedly had to go away, do you have a safe person that will care for your dog?
*
DETAILS OF YOUR VET
If you have one currently.
Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
ANYTHING YOU WOULD LIKE TO ADD
Submit
Should be Empty: