Pongo

Your Details

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Name of Applicant(s) *

Address Line 1 *

Address Line 2

Town / City *

Post Code *

Contact Number(s) *

Contact Email *

Family & Household

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Number of Adults and Ages *

Number of Children and Ages *

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

Yes
No

Is anyone in the household allergic to pets? *

Yes
No

Do you own or rent your home? *

Own
Rent

When did you move to the property? *

Is your garden secure? *

Yes
No

Please give a brief description of the garden

Are you planning to move in the near future? *

Yes
No

Employment Information

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Are you employed? *

Yes
No

Other Pets & Animals

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Do you own any other pets?

Yes
No

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

Yes
No

Veterinarian Information

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Practice you use/intend to use *

Vets name (if known) *

Practice Address *

Practice Telephone Number *

When did you last visit the vets?

Adoption Questions

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

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

Do you plan on getting insurance to help with vet bills? *

Yes
No

Are you willing to user a groomer if needed? *

Yes
No

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

Yes
No

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? *

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? *

Yes
No

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

Digging *

Barking *

Chewing *

Separation Anxiety *

Aggression *

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

Additional Information

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

Terms & Conditions

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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 *

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Pongo

9 Years, 5 Months old
Shih Tzu

Apply Here

About Me

My Likes and Dislikes

Type of Home I Need

Gallery

My Traits

Current Status

Your Details

Family & Household

Employment Information

Other Pets & Animals

Veterinarian Information

Adoption Questions

Additional Information

Terms & Conditions