DOG’S DETAILSDog's Name(Required) Breed Colour Tag Number(Required) Microchip(Required) PN Number(Required) Date of birth Day Month Year Sex(Required) Female Male Sterilised(Required) Yes No Sterilisation Due Date(Required) Day Month Year From 5 months of ageNext Innoculation Due Day Month Year Next Rabies Innoculation Due Day Month Year Next Dewormer Due Day Month Year Next Deflea Due Day Month Year Medical Treatment RequiredADOPTER'S DETAILSName(Required) First Last Primary contact number(Required)Secondary contact number(Required)Email(Required) ID Number (or Passport)(Required) Physical address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country ALTERNATIVE CONTACT PERSONName(Required) First Last Primary contact number(Required)Secondary contact number(Required)PET INSURANCEAre you interested in finding out more about pet insurance?(Required)YesNoTEARS adopters receive 50% off their first 3 months insurance premium when they sign up for dotsure.co.za pet insurance. Plus TEARS Animal Rescue will receive a R300 donation on your behalf. Dotsure.co.za was voted Best Pet Insurance Company in South Africa in the 2020 Star reader's Choice Awards, and has pet insurance cover from as low as R82 per month.Do you currently have pet insurance for your animals?(Required)YesNoConsent Dotsure.co.za can contact me with more information on pet insurance ADOPTION CONTRACTConditions of adoption(Required) I agree to all the terms: I herewith agree to the conditions of adoption. I acknowledge that I fully understand the conditions of adoption pertaining to sterilisation: puppies and kittens are to be sterilised at or before 6 months of age. I agree to hand over the said pet to TEARS Animal Rescue on request, should the Society find any of the pre-determined conditions of adoption have not been adhered to. If I fail to hand over the animal, TEARS may repossess it without further reference to me. I agree that the above information is true and correct. TEARS Newsletter Puppies and kittens in my inbox? Yes, please! I'd love to receive the TEARS Tails Newsletter! CommentsThis field is for validation purposes and should be left unchanged.