Adoption Application Form

	If you have applied to adopt in the last 6 months and your details have NOT changed, please do not apply again. Email adoptions@chaineddog.org.nz and let us know what dog you are interested in.
Last Name *
First Name *
Date of Birth *
Email Address *
Full physical Address *
City *
Are you Renting or do you Own the property you live in? If you are renting you will need to provide proof you are allowed a dog at your property such as a tenancy agreement. *	Owned Rented
Mobile Number *
Residency Status. i.e. Resident, Citizen, Visa etc *
How many people are at the address *
Ages of people living at the house *
Will the dog have regular contact with children under 5, or elderly people *
Why do you want to adopt a dog? *
I am a first time dog owner? *
I need a dog that is already trained *
I have obedience trained before *
Please provide information on current dog experience i.s. obedience class, behaviour training etc *
I have lots of experience and could handle a difficult dog *
Please provide ALL details of current pets (unless stock, then just name type). MUST include Name, Breed, Sex, Age, Desexed Y/N, Current Vax Y/N, Registered Y/N *
If you answered no to any of the previous questions regarding your existing animals, please provide further information *
Where do your current pets sleep? Please be specific eg kennel, verandah, laundry. If inside, which room? *
Where will your new dog sleep? Please be specific eg kennel, verandah, laundry. If inside, which room? *
Do your current animals have any behavioural issues? Examples of this are fear, reactivity, aggression towards other animals etc. Please explain what these are and the steps you are currently taking to help this. *
Which areas of the house/yard will your dog have access to, eg backyard only, backyard and laundry/kitchen etc *
Have you had any pets in the past? What happened to them? Have you ever taken an animal to a shelter or released it to another party? *
Is your yard securely fenced? Describe type of fencing (wooden, wire etc) and height at lowest point. If you have a pool is this separately fenced? *
If no-one is at home, where will the dog stay? Inside or Outside? If the dog is outside, what type of shelter will the dog have? *
How many hours will the dog be WITHOUT human company for each day? *
How often will you have time to walk the dog? How long for? On or off lead? *
Under what circumstances would you give up this pet? e.g. family illness, barking, digging, shedding, biting, moving house, housetraining, high cost vet bills? *
If you are renting please provide us with your landlords written verification that a dog is permitted. If this is not provided, we cannot proceed further.
How many dogs are allowed by your council? If you are unsure please look up your local laws and advise, or provide your multi dog licence if required. *
Employment Status *	Part Time Employed Full Time Employed Self Employed Student Retired Stay at Home Mum or Dad Unemployed
Name of employer/business *
Age of dog preferred *	Puppy under 1 year 1-2 Years 2-7 Years 7+ Years No Preference
Sex of dog preferred *	Male Female No Preference
Size of dog preferred *	Small under 7kg Medium under 15kg Large over 15kg No Preference
Name of DOG(S) you are interested in. This is the name we have them advertised under, not your own name. *
Are you willing to come to Auckland to meet the dog? Or Cromwell/Gore for the dogs located there. NB: If you are not willing to travel to meet the dog your application will NOT be considered. *
Emergency Contact - Name, Phone Number, Email *
Do you currently have a vet? If so, please provide us their name and phone number so we can contact them for a reference, together with one personal referee. If you do not have a vet please provide two personal references (must not be living with you). We reserve the right to contact these referees should the application proceed. *
Please tell us about you, your family, hobbies or your interest in adopting a dog? The more information you provide, the better we will be able to determine suitability. *
Is there any further information you would like to attach to support your application?
*	Declaration: By submitting this questionnaire, you agree that ALL the information you have provided is correct.