Clone of Cat Adoption Application

Dog Expression of Interest Form

General Information

Your home

Current and past pets

Training and stimulation

Veterinarian

Personal References

Terms & Conditions

Dog Expression of Interest Form
CAMPASPE AND RIVER MURRAY ANIMAL REHOMING INC (CARMAR)
ABN: 1966 540 9543 INC: A0097781B
PH: 0447727439
carmarechuca@yahoo.com www.carmar.net.au
PETRESCUE ID: 11372

Echuca Victoria
Name of dog that you're applying for*
General Information
Name of Applicant*

First NameLast Name
Name of partner or significant other

First NameLast Name
How long have you been in this relationship?
Which age group do you belong to?*

18-3031-4546-6061-7576+
Names and ages of children (if any)
Home Address*

Street Address

Street Address Line 2

TownState

Post codeCountry
Phone Number*
Format: 0000 000 000.
Email Address*
Your home
Do you live in a:*

HouseApartmentUnitFarmMobile homeOther
Do you own or rent your home?*

OwnRentI live with a parent, guardian or family member
If you don't own the home the pet will be living in, will you attach written permission from the property owner?

YesNo
Attach permission

Cancelof
For how many hours each day will the dog be home alone on a typical weekday?*
For how many hours each day will the dog be home alone on a typical weekend?*
Where will the dog be when it is home alone?*
What size is your yard?*
What shelter will the animal have?*
What material are your fences?*
How high are your fences?*
If you have a pool, is it separately and securely fenced to prevent pet access?*

YesNoN/A
When you are at home, what percentage of the time will the dog be inside?*
Where will the dog sleep at night?*
Current and past pets
Do you have any pets currently?*

YesNo

Do you have any livestock, including sheep, cattle, horses, chickens etc*

YesNo
How will you introduce this dog to livestock?
Have you had any pets of your own in the past?*

YesNo - this is my first pet
Please list all pets you have had in the past (breeds ect)
Have you ever sold, given away, or surrendered a pet to a shelter or rescue? If yes, please provide details*
What would be the reason that you would return or rehome an animal?

BarkingDiggingAggression to peopleAggression to animalsChewingAnxietyToileting insideStrong prey driveMedical issues
If any of the above have been ticked, please elaborate:
Who will be the primary carer of the dog?*
What are the reasons for adding a dog to your family?*
How long have you been looking for a dog?*
Please give 3 reasons you think this dog will be a good fit for your family?*
Training and stimulation
What mental stimulation will you provide for the dog?*
What physical stimulation will you provide for the dog?*
How will you approach socialising this dog to ensure it develops appropriate social behaviours with other dogs?*
Please summarise how you will approach training of this dog?*
Veterinarian
Vet Clinic*
Vet Clinic Phone*
Format: 0000 000 000.
Do you have the financial means to care for your cat in the event of a medical emergency?*

YesNo
Personal References
Reference 1*

First NameLast Name
Reference 1*
Format: 0000 000 000 .
Relationship to Reference 1*
Ex. Neighbor, coworker, roommate, family friend
Reference 2*

First NameLast Name
Reference 2*
Format: (000) 000-0000.
Relationship to Reference 2*
Ex. Neighbor, coworker, roommate, family friend
Terms & Conditions
I certify that I am at least 18 years of age*

AgreeDisagree
I hereby authorize CARMAR to contact my references, veterinarian(s), and landlord to verify said statements.
Applicant Name*

First NameLast Name
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Type of Animal/breed

Desexed? (Y/N)

Up-to-date on vaccines? (Y/N)