Adoption Application Please allow 15-30 minutes to fill out this form Date of application * Name of dog you are interested in adopting (or specify that you are wanting a best match): * First Name * Surname * Phone Number * Alternate Phone Number Email Address Residency Status * Choose One NZ Citizen Permanent Resident Other If answered "other" above please give details: What is your current employment status? * Choose One Full-Time Part-Time Casual ACC Retired Work from Home Stay at Home Parent Student Unemployed Other If answered "other" above, please give details: If you are employed, what is your current occupation? * Including yourself, please give the name and age of each person in your household, and their relationship to you: * Does anyone in your household have allergies to dogs? * Choose One Yes No Possibly Is there anyone in your household that is nervous or fearful of dogs? * NoYes If answered 'yes' above , can you please provide further information on this? Have you or anyone else in your household: got any pending charges and/or ever been convicted of abuse, cruelty or neglect of a child or animal? * Choose One Yes No If yes, please give details: Your street address (where you live) * Suburb * City * Post code * How long have you lived at this address? * Please select your current residence type. * Choose One House Apartment Flat Townhouse Mobile Home Other If you answered "other" above, please give details: Do you own or rent your home? * Choose One Own Rent I live with the owner of the home I live with the person who rents the Home Other If answered "other" above, please give details: Do you agree to providing your landlord/property manager with our landlord consent form to complete and return to us? * Choose One Yes No Unsure N/A Is your property securely fenced? * Choose One Yes No If yes, please describe your fencing. If no, please describe how you intend on containing the dog on your property: * Please tell us why you want to adopt a dog: * Ideal age of dog Choose all applicable Puppy 8-12 weeks old 5 - 12 months old 1-3 - 5 years old 5 - 8 years old 8 + years old any age is ok Ideal sex of dog Choose One Male Female Either Ideal size of dog Choose all that apply Small 1-10kg Medium 12-26kg Large 27-44kg Giant 44+kg any size is ok What activities will you do with your dog and how often? What pets/animals are living on your property? * Select all that apply Dog Cat Rabbit Guinea-Pig Rats/Mice Birds Fish Livestock We don't own any other pets If you have a dog(s), please specify their age, sex & breed If you have a dog(s), is it currently up to date with: Select all that apply Vaccinations Desexing Registration Microchipping Have you owned any dogs during your adult life? * Choose One Yes No If yes, please include the following information about each dog you have owned: Age owned from - to, dogs name, breed, sex, current/deceased/rehomed On average, how many hours per day will the dog spend alone, without human company and where will they be during this time? * Where will the dog spend the night/sleep? (please be specific) * Where will the dog spend the day? * Which areas of the house/yard will the dog have access to? (please be specific) * When the dog is outside, what type of shelter will the dog have? * Are there times when the dog will be tied/chained up? * Choose One Yes No Unsure Are you comfortable adopting a dog that needs toilet training? * Choose one Yes No Unsure If yes, how would you toilet train your dog? Are you comfortable adopting a dog that needs on-going medical treatment? * Choose One Yes No Unsure Are you comfortable adopting a dog that is NOT cat friendly? * Choose One Yes No Are you comfortable adopting a dog that requires further socialisation with other dogs or that is not dog friendly? * Select all that apply No – this dog must be well socialised and dog friendly Yes – I am confident in dealing with a dog that requires ongoing socialisation Yes – I am comfortable with adopting a dog that is not dog friendly Unsure Are you comfortable adopting a dog that is timid or wary of humans at times or that is fearful of children? * Select all that apply No - the dog must be well socialised with all humans Yes - I am comfortable adopting a dog that is timid or wary of humans at times Yes - I am comfortable adopting a dog that is timid or fearful of children Unsure Are you comfortable adopting a dog that requires basic training? * Choose one Yes No Unsure If yes, how would you train your dog? Have you had experience with difficult dogs? * Choose one Yes No Unsure If answered "yes" above, please give details: Have you ever surrendered, sold or given-away a dog? * Choose One Yes No If yes, please give details? Have you ever had a pet euthanised for reasons other than age or health? * Choose One Yes No If yes, please give details: Are you willing to take responsibility for this dog for the next 10-20 years? * Choose One Yes No If no, please give details: Under what circumstances would you consider giving up this dog? * Choose all that apply barking digging shedding biting moving house family illness high vet costs loss/decrease of income seperation/divorce having a baby I would never give up my dog other If other, please give details Is there anything else you would like us to know when considering your application? * If you were successful with adopting a dog, how soon could you take the dog? * How did you find out about Dogwatch/this dog? * Choose One Dogwatch Website Internet Search Family/Friend Staff/Volunteer Social Media Dogwatch Event Drove Past Billboard Other I consent to Dogwatch carrying out a property visit as part of my application. * Choose One Yes No I acknowledge: that Dogwatch does not operate on a ‘first in, first gets the dog’ situation; that Dogwatch does its best to ensure each dog goes to the home that will suit that dog’s needs and personality best; that in completing this application I am not guaranteed to be selected to adopt a dog; that Dogwatch reserves the right to refuse any application with or without reason; that if my application is successful it will be pending a property check; that once my property is approved, I will be required to sign an adoption agreement with further terms and conditions. * Choose one Yes No I certify that all information provided/answers given in this application for adoption are complete, true and not misleading in any way. * Choose One Yes No Privacy statement. I understand and agree that this information is being collected by Dogwatch Sanctuary Trust (“Dogwatch”) to assess my suitability to adopt a dog; that this information will only be used in relation to this application or a subsequent application; that I have the right to access the information and ask for any incorrect or out-of-date information to be amended; that information within this application will not be made available to any third party without my permission. * Choose one Yes No This information has been collected by Dogwatch for the purpose of communicating with you in relation to your application or subsequent application to adopt a dog from Dogwatch. Do you give permission for Dogwatch to include you on its email mailing list and to send you correspondence about (but not limited to) promotions, fundraisers and events? * Choose One Yes No I acknowledge: That I must provide either home ownership proof or rental permission from the home owner of my rental property stating I can have a dog living on the premises and that I will submit this within 48 hours of submitting this application form * Choose One Yes No
