Adoption Application Form

First Name *

Last Name *

Date of Birth *

Email Address *

Physical Address *

City *

Living Status *

Mobile Number *

Residency Status *

Number of people living 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 *

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 *

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. *

Where do your current pets sleep? Where will your new dog sleep? Please be specific eg kennel, verandah, laundry. If inside, which room? *

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? *

Employment Status *

Name of employer/business *

Age of dog preferred *

Sex of dog preferred *

Size of dog preferred *

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 for the dogs located there. *

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?

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Declaration: By submitting this questionnaire, you agree that ALL the information you have provided is correct.