DOG’S DETAILSDo you know which dog you would like to adopt?*YesUndecided, would like to adopt an adultUndecided, would like to adopt a puppyI would like to apply to adopt:*APPLICANT’S DETAILSName and surname*Your age*Under 1818-2425-3435-4445-5455-6465 or AbovePhysical address*Contact number*Additional contact number*Email* LIVING SITUATION/ENVIRONMENTTo what extent is your property secured? Please describe the height and type of your perimeter boundary and gates.*Do you own or rent your home? If you rent, do you have permission to keep pets and are there any restrictions?* Home owner Rent, have landlord's permission Rent, need to ask for landlord's permission Is your home a free standing house, apartment or complex?* Free standing house Apartment/flat Complex Small holding Other Where on your property are pets not allowed?*Are there times when the dog/s will be tethered or tied up?*YesNoWill your dog spend any time in the garage?*YesNoDo you have a swimming pool or large pond?*No swimming pool or pondYes, enclosed swimming pool or pondYes, covered swimming pool or pondYes, not covered or enclosedWhen you open your driveway gate, will your dog be behind a barrier?*YesNoYOU AND YOUR HOUSEHOLDYour employer and occupation*Your partner's employer and occupationHow many hours a day will the dog be without human supervision?*1 - 2 hours3 - 5 hours6 - 9 hours9+ hoursWho is at home during the day?Do you take your dogs with you when you go away?*YesNoWho would look after them while you are away?*Does a member of your household have an allergy to dogs?*YesNoChildren and your home:* I have children (0 - 6 years) I have children (6 - 12 years) I have children (13+ years) Children visit my home (0 - 6 years) Children visit my home (6 - 12 years) Children visit my home (13+ years) Children rarely visit my home How many adults live at your home (other than yourself)?*01234+How do they get along with pets?*Do you have a domestic worker or gardener?*NoYesHow do they get along with pets?*What is your dog experience?* First time dog owner Have had one or two dogs Have had many dogs Volunteered at an animal shelter Have attended dog training classes Will you be willing to take your new family member to puppy school/dog training classes? Yes, all puppies need to go to Puppy School No, I will train my own puppy at home Happy to go to Dog School with my new dog No, would like a dog who needs minimal training What characteristics do you desire or could accept from a dog?* Very active, running companion Not very active, couch potato Calm, gentle and well mannered Accepts strange dogs happily Accepts strange people happily Reserved, shy Confident, outgoing Pushy, tests the boundaries Protective of family and home Clingy, dependent Independent Affectionate, loves cuddles High energy Playful Why do you want to adopt a dog?* Family pet Companion for yourself Companion for your kids Companion for your other pets Sport/agility Watch dog Guard dog Hunting Breeding Other Other:*Do you currently own any pets?*YesNoPets currently living with you (click on the + button to add another pet):*Pet's nameAgeGenderSpecies and breedIs this pet kept inside, outside or both?How did you acquire and how long have you had him/her?Is this pet up to date on vaccinations?Sterilised? If not, please explain why:How does this pet get along with new dogs?If this pet is a dog, has it been to puppy or obedience classes? Past pets who have lived with you (please list all pets you have had in the past 5 years, click on the + button to add another pet)Pet's nameAgeSpecies and breedHow long did you have him/her?Why do you no longer have this pet? GENERAL INFORMATIONHave you ever surrendered a pet to a shelter?*NoYesPlease explain why:*Have you ever had a pet euthanased?*NoYesPlease explain why:*A shelter dog may not be housetrained. How will you teach your new dog to use the outside facilities? Positive reinforcement and reward with praise and/or treat when using the outside area Take dog outside routinely throughout day, after meals and naps Reprimand accidents, rolled up newspaper, spray bottle, etc How often and where would you take the dog for walks?*What type and brand of food would you feed the dog?*How do you feed your dog?*Leave food out all dayTake food away after a period of timeWhere will your dog spend most of the time during the day?*Where will the dog spend most of the time at night?*Have you ever applied to an animal shelter to adopt a pet?*NoYesWhich organization/s?*Are you willing to take responsibility for a new dog for the next 10 - 15 years?*YesNoWhat provisions will you make for your pets should you become unable to care for them (emigration, death, financial difficulties, etc):*Are you able to afford private veterinary care for your existing pets and a new addition?*YesNoREFERENCESVeterinary Practice Name of practice Contact number A family member or person living with you Name Contact number A family member or person NOT living with you* Name Contact number ADOPTION SURVEYHow did you hear about TEARS Animal Rescue?* Printed media (newspaper, magazine, poster, etc) Google Facebook Instagram Twitter Have previously adopted from TEARS Recommended by a friend or family member Other
