Bertie

I would like to *
AdoptFoster

I would like to foster/ adopt a *
DogsCatsDogs or CatsSmall Animal

Would you prefer long or short-term fosters
Long-termShort-termI don't mind

Who is you application to Adopt/ Foster for?

Name of Lead Applicant *

Full Address *

Contact Number(s) *

Contact Email *

Full Names and Date of Birth for all Adults *

Full Names and Date of Birth for all Children *

Have all members of the household agreed to foster/ Adopt? *
YesNo

Is anyone in the household allergic to pets? *
YesNo

Details of allergies

Do you own or rent your home? *
OwnRent

Landlord Name or Estate Agent Name

Landlord or Estate Agent Contact Number

Landlord or Estate Agent Address

Landlord or Estate Agent Email

Do you have landlords permission to adopt a pet?
YesNo

Property Type *
Detached HouseSemi-detached HouseTerraced HouseTown HouseBungalowFlat/ApartmentOther

When did you move to the property? *

Are you planning to move in the near future? *
YesNo

New Address (if known)

Is the Garden Secure? *
YesNo

Brief Description of the Garden *

Are you employed? *
YesNo

Employer

Job Title

Period of Employment

Hours worked per Week

How long will the animal be left?

Are you at risk of becoming unemployed?
YesNo

Please provide details of how you will provide for the animal

Do you own any other pets? *
YesNo

Names

Breeds

Ages

Genders

Are they all neutered?
YesNo

Is there a reason for not neutering?

Temperaments

Have you ever given an animal away or handed into a rescue? *
YesNo

Please give details

Practice you use/intend to use *

Vets name (if known)

Practice Address *

Practice Telephone Number *

When did you last visit the vets?

Why did you last visit the vets?

How long have you been looking to foster/adopt? *

How much time are you prepared to allow for him/her to settle in? *

Are you willing to use a groomer if needed? *
YesNo

Do you have your own method of transport? *
YesNo

Are you committed to providing a responsible and loving home to your adopted animal for his/her entire life? *
YesNo

In case of emergency who will care for the animal? *

Where will the animal be kept during the day? *

Where will the animal be kept at night? *

Will you use a crate to help train the dog? *
YesNo

How long will you walk your adopted dog for, and how many times a day?

Where do you intend to walk your dog, how far is it from your home?

Are you willing to train your dog if needed? *
YesNo

Please give the contact details of a qualified dog trainer/behaviourist in your area

What would you do if your dog develops problems with the following...

Digging

Barking

Chewing

Separation Anxiety

Aggression

What would you do if your Cat develops problems with the following...

Not using litter tray

Scratching Furniture

Aggression

Please use this space to tell us anything else about yourself, your family, your home and / or your animals.

By signing below, I certify that the information I have given is true. I understand that Chesterfield Animal Rescue reserves the right to deny my application for any reason. I further authorise the investigation of all statements in this application.
I Agree

If successful do you agree to share your details with Agria for 5 weeks free insurance?
YesNo