New Dog Adoption Application
Name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit 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
Which dog are you applying for? (If any)
Tell us about the dog you’d like
Breed, age and temperament
Would you consider fostering to adopt?
What is your occupation?
Your work hours and days
*
Shift patterns, home at lunch, hours worked
How many hours will the dog be left alone for?
*
How will the dog be cared for when left alone?
*
Crate, family pop in during the day, a dog walker?
Who else lives in the home? Please state their ages and any dog experience they have
*
Do children visit regularly? Include their ages
*
How often do they visit? Do they have experience with dogs?
Any major changes expected in the next 6–12 months?
*
Moving house? Having a baby? Home renovations or change in work hours
Any medical conditions in the home we should know about?
*
If you could no longer care for the dog, what would you do?
*
Does everyone in the home agree to adopt?
What kind of home do you live in?
*
House
Flat without garden
Flat with Garden
Bungalow
Other
If other please state:
Tell us about your home and area
*
What is your street like? Do you live near a busy road?
What best describes your housing situation?
*
Own your home
Private rent your home
Rent from other sources
If renting, who is your landlord?
*
Tell us about your garden and fencing
*
Fence height, type of lawn and any gates
Any holidays already booked?
*
How much exercise and training can you offer?
*
Where will you walk, busy or quiet areas? what type of training do you prefer?
Tell us about your dog experience
*
Previously owned dogs, dogs you have looked after or worked with
Would you stay committed through any issues?
Do you have another dog in the home?
*
Do you have any other pets in the home? Please list them below, are they vaccinated and neutered? Have they lived with a dog before? Do you have any visiting animals? if so please add them to the form too.
*
Please let us know where small animals are housed
Are you applying elsewhere?
Have you ever returned or rehomed a dog?
*
Please give details on how you will settle a new dog into your life and home
*
Think about visitors, where the dog will sleep and other pets
Do you drive?
*
yes
no
Would you travel to meet the dog?
*
Yes
No
Depends on distance
How far would you travel?
Are you financially ready for a dog?
*
Why are you a good fit for a rescue dog?
*
How did you hear about us?
Do you consent to us retaining your data for future reference?
*
Yes
Please provide two references
*
Rows
Full name
Contact details
Reference
Reference
Today's Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Sign and submit your adoption application
*
Back
Next
Submit
Should be Empty: