(Rehoming) DOG Pre Adoption Questionnaire

Dog/Puppy Pre Adoption Questionnaire
All personal information supplied by you on this application form will be processed by the Royal Society for the Prevention of Cruelty to Animals whose privacy policy is available and published at: www.rspca.org.uk/privacy or on request by calling Supporter Services on 0300 123 0346. This applies whether the information is supplied directly to the national RSPCA (charity number 219099), as data controller, or is shared with us by an RSPCA Branch (a separately registered charity) as a joint data controller. The term “RSPCA” will refer to both data controllers. By continuing with this application you confirm you have read and understood our Privacy Policy.
Dog you are interested in*
Are you ready to adopt as soon as a home visit is completed? (usually within 5-7 days of viewing the dog) If not please get back to us when you are in position to proceed *
Your Full Name*

First NameLast Name
E-mail*
Full address and Postcode*
Home Phone Number (please enter zero's if you have no landline)*

Area CodePhone Number
Mobile Number (please enter zero's if you have no mobile)*
Are you a permanent UK resident?

YesNoOther
Age range of the main carer of the dog*

18-2526-3536-4950-6061-7070-7576-8081+
Number of adults 18+ in your household & relationship*
Number of under 18's in your household and their ages
Are there any children who visit the property regularly? If yes, please state their ages*
Are there likely to be any changes in the near future ?(eg new baby/moving/operations/building work etc)*
Are you due to go on holiday in the next six months? If so what dates and what provisions will you make for the dog (ie dog would go with you/boarding kennels etc)*
Is the above address*

HouseBungalowFlatMaisonetteOther
If flat which floor?
Is the above address*

OwnedRented privatelyCouncilHousing Association
If in rented property, we will need evidence of your permission to have pets from your landlord before proceeding. Do you have written permission? If not, please obtain permission first and reapply.

YesNoOther
Is there direct access to a private garden?*

YesNo
Is the garden securely enclosed?*

YesNo
Approx garden size & type & height of fencing/boundaries*
Do you work?*

Full timePart timeDon't workRetiredLooking for workOther
How many days a week do you work?
How many hours a day do you work?
How many hours would the dog be left on its own a day, and why?*
Do any household members have medical problems affected by animals ?(ie allergy)*
Have all members of the household been in contact with dogs?*
Have you owned a dog before?*

YesNo
If yes for how long and what breed/type etc?
Please give details of your experience. ie novice/experienced/used to working with behavioural difficulties etc - be as detailed as possible to help us match the right dog with you*
Do you have any pets already?*

DogCatRabbitNo current petsOther
Please provide details of all current pets including breed/age/sex/temperament
Have you ever had to part with an animal you owned before? (ie rehomed). If yes under what circumstances*
Are your pets neutered?

YesNoOther
Are your pets vaccinated?

YesNoOther
Have existing animals lived with dogs?

YesNoOther
How much daily exercise would you give a dog and where? (eg park/woods/street)*
Are you prepared to provide appropriate positive training and socialisation suitable for the breed/age/temperament of the dog/puppy?*

YesNo
How active are you?*

VeryReasonablyNot very
Name and location of your veterinary surgeon
Are you prepared to seek veterinary advice on routine vaccinations, worming, and flea control and to cover the cost incurred?*

YesNo
Are you in agreement that a pre and post adoption home visit is carried out?*

YesNo
How long have you been looking for a dog?*
What drew you to this dog and why do you feel they'd be a great match for you? Please give as much detail as possible*
An adoption fee will be payable if you go on to adopt a dog/puppy from us. Fees range from £60 to £395 depending on the dogs breed/age/health status. We can only accept direct bank transfers and cash, there are no card payment facilities available currently. Please check box to confirm you have read and understood this.*

Yes - I agree to pay the relevant adoption fee for this dog/puppy
Use this box to tell us in your own words why you feel you are a perfect match for this dog!
Should be Empty:

Dog/Puppy Pre Adoption Questionnaire