Adoption Form

APPLICATION TO ADOPT A DOG WITH RESCUE HUB INC
Please complete Application FULLY to be considered for one of our dogs.
Incomplete Applications may not be accepted - all questions require complete answers.
Please fill in the details and then click the SEND APPLICATION button at the end
Name of Applicant/s:*

First NameLast Name
First NameLast Name
Residential Address (No PO Boxes):*

Street Address

Street Address Line 2

CityState

Postcode
Home Phone Number:*

Area CodePhone Number
Mobile Phone Number:*
E-mail Address:*
How did you hear about our dogs?*
What is the name of the foster dog that you are interested in adopting?*
Are you employed?*

Full timePart-timeUnemployedPensionerRetiredStudent
How many adults live in your household?*
How many children live with you and what are their ages?*
How many hours a day and how many days per week will your dog be at home without the company of at least one family member even if there is a companion dog/s?*
Do you have any other pets?*

YesNo
Please specify type / breed / sex and whether desexed:*
If you have other pets, are they vaccinated?*

YesNo
Have you owned a dog before? *

YesNo
If you answered Yes to the above question, please tell us when and for how long you had your dog(s):*
Where is this dog now? *

At homeHeavenRe-homedSurrendered to a shelter
If rehomed or surrendered - for what reason? Please elaborate*
In your opinion, which of the following circumstances justifies surrendering a pet? You may check one or more*

Moving housePersonality clash with another petEscaping from your yardChildren have lost interest and no longer take responsibilityToo time consumingOngoing medical problemsFears for the safety of a new babyDivorce / Partnership break-upCoat sheddingFinancial problemsToilet training problemsExcessive barkingFear of pet being lonely while you're away from the homeNone of the above - a pet is for lifeOther
Your home:*

HouseTown House/VillaApartmentUnit FlatAcreage
Do you:*

OwnRent*Live with parents**
Do you have secure fencing (at least 1.8m high)?*

YesNo
Approx. size of fenced area where your dog will have access and be secure:*
Do you have a dog door? *

YesNo
Is your motor vehicle air-conditioned? *

YesNo
Do you have a pool?*

YesNo
Is it fenced? *

YesNo
If not fenced, does the pool have steps or a ladder to get out?*

StepsLadderOption 3
Where do you envisage your dog will sleep?*
Do you pledge to have your dog vaccinated, wormed and heart-wormed at the required intervals?*

YesNo
Do you pledge to purchase products that will keep your dog flea and paralysis tick free?*

YesNo
Do you pledge to seek Veterinary treatment when required?*

YesNo
Do you pledge to return the dog to us if you encounter any difficulty?*

YesNo
Do you pledge to love and care for your dog and consider his/her needs to be of supreme importance?*

YesNo
Would you allow your dog to come inside?*

YesNo
Would you agree to allow us to visit you at your home prior to adoption?*

YesNo
Would you object to an occasional phone call from us to inquire about his/her well-being?*

YesNo
Is there anything else that we should know to help us assess your application?*
I/We realise the commitment I/we are making to my/our dog and agree to honour all Pledges made within this application*

AgreeDo NOT agree
Name of your usual veterinarian:*

First NameLast Name
Phone Number of your usual veterinarian:*

Area CodePhone Number
Names and numbers of two (2) personal referees*
*
I/We agree to relinquish this dog if it is established that I have given false or misleading information in this application OR if allegations of abuse or neglect are reported to Rescue Hub Inc or any other animal welfare agency.*

AgreeDo NOT agree
Should be Empty:

APPLICATION TO ADOPT A DOG WITH RESCUE HUB INC