Dizzy Chihuahua Rescue Application form
Please ensure you answer ALL the questions. Leaving out answers may lead to an application being rejected. If you are unable to answer a question or a question is not applicable to you, please put 'n/a' so that the form is complete when being submitted.
What is the name of the Dog you are applying for?
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Should you be unsuccessful for this dog, would you be interested in other DCR dogs
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male
female
puppy- 2 years
3-6 years
7 or older
Name
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First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Address
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Address
Address Line 2
postcode
How long have you lived at this address
Phone number (home or Mobile)
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Email
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example@example.com
Occupation
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If self employed, name of business and website address (or write NONE if not employed / working)
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Full name and Address of Employer (please include employer / manager / HR email and phone number) or write NONE is not employed / working
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How many hours a week do you work?
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How many hours per day do you typically work on a Monday?
How many hours per day do you typically work on a Tuesday?
How many hours per day do you typically work on a Wednesday?
How many hours per day do you typically work on a Thursay?
How many hours per day do you typically work on a Friday?
How many hours per day do you typically work on a Saturday?
How many hours per day do you typically work on a Sunday?
If you work from home, is this a permanent situation? Written confirmation from employer will be required)
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Yes
No
N/A Do not work from home
How many hours per day do you spend at home between 7am - 11pm (this is spending leisure time at home with the dogs)
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Describe how you would typically be spending time with your dog Monday to Friday
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Describe how you would typically be spending time with your dog at the weekend (Saturday & Sunday)
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Do you plan to use a dog walker
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Yes
No
Partners Name
First Name
Last Name
Partners Date of Birth
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Month
-
Day
Year
Date
Partners Occupation
Partners employers details - Name / address / contact
How many hours a week does your partner work?
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How many hours per day does your partner typically work on a Monday?
How many hours per day does your partner typically work on a Tuesday?
How many hours per day does your partner typically work on a Wednesday?
How many hours per day does your partner typically work on a Thursday?
How many hours per day does your partner typically work on a Friday?
How many hours per day does your partner typically work on a Saturday?
How many hours per day does your partner typically work on a Sunday?
If your partner works from home, is this a permanent situation? Written confirmation from employer will be required)
Yes
No
Is your partner in FULL agreement to adopt a rescue dog
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YES
NO
I DO NOT have a partner
How many other people live in your household - please give details and ages (Please write NONE if no one else lives with you)
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Are you expecting / planning on having a baby
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YES
NO
Do you have visiting children - please give details of how often do they visit, ages etc (Please write NONE if no children visit you)
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Will anyone else in your home be responsible for looking after the dog - please give details
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Next
Do you rent or own your own home?
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OWN HOME
RENT HOME
If renting, do you rent from ...
Private landlord
local authority / council
housing association
Other
if other, please explain
If renting, do you have written permission from your landlord to keep a dog? PLEASE PROVIDE THE TENANCY AGREEMENT / WRITTEN PROOF FROM YOUR LANDLORD STATING THAT PETS CAN BE KEPT IN YOUR PROPERTY
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YES
NO
N/A (not renting)
Landlords details - Name and contact details (phone / email) or write "N/A not renting"
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What type of accommodation do you live in?
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detached house
semi detached house
terraced
bungalow
flat
Other
Do you have a secure garden with a well constructed fence? (secure built solid fence - wood, composite etc)
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YES
NO
How high is the fence? (height of solid built fence only)
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Is the property Alarmed?
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YES
NO
Does the property have a pond?
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YES
NO
If YES, how deep is the pond and is it covered / raised
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Do you currently own a Chihuahua?
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YES
NO
If YES, Please give brief details (how many, sex, how long owned, where they/ it came from etc)
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Have you previously owned a Chihuahua?
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YES
NO
If YES, Please give brief details (how many, how long owned, were they rehomed / passed away etc)
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Do you own any other pets? (please give details.. breed / gender/ etc)
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Are all the the animals in your home vaccinated annually ?
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YES
NO
Are all the the animals in your home spayed / neutered ? (Veterinary proof of spay required)
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YES
NO
Name and Address of your veterinary practice
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Have you applied for a rescue dog before?
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YES
NO
Please provide details of rescue / charity you have applied to / are currently applying from
Have you had a home check from another rescue before?
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YES
NO
Please provide details of rescue / charity you have had a home check by
Do you have visiting dogs to your home? (family/ friends)
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YES
NO
Please give brief details
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Next
Where would the dog sleep?
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Do you plan to crate / cage the dog for any periods of time
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YES
NO
How often would the dog be walked?
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Would the dog be in a safe alarmed place in the home if you had to go out?
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YES
NO
Chihuahua's are intelligent dogs so how would you prevent boredom and provide mental stimulation?
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How would you create a safe haven for a little dog?
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How would you recognise stress in the dog and help it settle
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Do you have a holiday planned this year?
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YES
NO
What arrangements would you make for your dog while you are on holiday?
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Would you take out pet insurance?
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YES
NO
How much do you think pet insurance would cost per year?
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How much do you think it would cost to feed a Chihuahua per week?
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Are you happy to have a home check?
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YES
NO
Do you suffer from any physical or mental illness?
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YES
NO
If yes, please give details..
Would you be prepared to travel and collect your dog?
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YES
NO
If successful in adopting and in the event that your rescue dog becomes ill, do you agree that you will ensure full veterinary treatment will be sought and given?
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YES
NO
In the event of a change of circumstances in which you are no longer in the position to keep ( or want )the dog, do you agree to keep (Suzanne Callan) Dizzy Chihuahua rescue fully informed and agree that the dog would be returned to us at Dizzy Chihuahua rescue to be rehomed.
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YES
NO
Would you be happy to keep in touch with us via DCR Facebook on a friendly basis to give us updates of the dog(s) as well as send us photographs / videos of the dogs.
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YES
NO
Please provide the name, address and phone number of someone you have known for more than two years who can provide a reference
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Please check your form and tick the box once ALL questions have been answered. If you are unable to answer a question, please fill in 'N/A' in the space
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I confirm that I have answered EVERY question or filled in 'N/A' for any unanswered questions. I confirm my form is complete
I confirm that the above information is correct and true and give authority for Dizzy Chihuahua rescue to contact any persons named in this application to obtain any further information if required. I agree that by filling in my full name below, it will be considered an online signature and therefore legally binding for the above information.
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Sign using your full name
Date
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Month
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Day
Year
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