A FEW DETAILS ABOUT YOU
First Name *
Last Name *
Address *
Town *
Postcode *
Main Telephone Number *
Secondary Telephone Number
Email *
Our preferred contact is via email, please indicate if you wish us to use other details above to contact you.
YOU ARE INTERESTED IN:
Please indicate if you have any preference of the Breed/Size/Age of dog you are looking for? *
Have you seen a particular dog that you are interested in. If so please tell us the name/s?
Would you be open to our rehoming team suggesting other potential matches? *
No Yes
A LITTLE BIT ABOUT YOUR HOME:
Type of accommodation? *
House
Bungalow
1st Floor Flat
2nd Floor Flat
Caravan
Other
Please upload some photos of the shared rooms in your home, the rooms we imagine your dog would spend the majority of his/her time. We ask for these so that we can make sure your home environment is both safe and suitable for the dog you have applied for
Please upload a photo of your houses entrance *
Please upload a photo of your lounge *
Please upload a photo of your kitchen *
Please upload a photo of the dining area
Do you own or rent your home? *
I own my own home
I rent from a housing association
I rent from a private landlord
If you rent - you will need to provide written permission from your landlord or Housing Association before meeting with an animal. Please upload your permission here.
Do you have a garden? *
Yes
No
Communal
What size is the garden? *
Small
Medium
Large
Are all areas of the garden secure from escape? *
No Yes
If the garden is unsecure, how do you plan to prevent escape?
Please upload photos of your garden including the fence *
Additional garden images
Additional garden images
Additional garden images
Additional garden images
Additional garden image
A LITTLE BIT ABOUT YOUR FAMILY:
How many adults live at home? *
How many children live at home? *
Please provide the ages of any children? (If no children live at home, please enter Not Applicable) *
Do you have any children that visit your home? *
No Yes
What are the ages of the visiting children? *
How frequently do they visit? *
Daily
Weekly
Monthly
Annually
Have all members of your family been in contact with dogs before? (This is to rule out allergies to dogs) *
No Yes
Do you own any other pets at the current time? *
None
Dog/s
Cat/s
Small Furries
Bird/s
Other
If you own other dogs, please state if they are male or female? *
N/A
Male
Female
If you currently own dogs are they all neutered? *
N/A
Yes
No
Have your other pet/s lived with or are used to dogs? *
N/A
Yes
No
If you own other dogs at the current time, please tell us a little more about their personality, energy levels etc?
Do you have any visiting animals (e.g. family/friends cats and dogs)? if so, please give details:
A LITTLE BIT ABOUT YOUR LIFESTYLE
What are your working hours? *
What would your expected exercise plan be for a new dog? i.e how long would you walk the dog and where, on and off the lead *
How long will you need to leave the dog alone on a regular basis? *
Is this: *
Daytime
Evening
Night-time
Would this time be continuous or would there be breaks? *
How often would this be? *
Are you planning on moving house within the next 3 months or going on holiday in the next month? *
No Yes
If going on holiday, where will your dog stay during this time?
Are you likely to have any major changes in your household over the next 4 - 6 weeks? For example, building works. *
No Yes
If yes, please provide details *
Are you able to take on a dog that has extra costs due to a medical condition? *
No Yes
YOUR IDEAL DOG WOULD:
Must be good with cats *
Very important
Quite important
Not important
Must like other dogs *
Very important
Quite important
Not important
Must be sociable around people *
Very important
Quite important
Not important
Should be comfortable around children *
Very important
Quite important
Not important
Must be house-trained *
Very important
Quite important
Not important
Should be comfortable travelling in vehicles *
Very important
Quite important
Not important
YOUR EXPERIENCE
Have you previously owned a dog? *
Yes, while growing up/as a child
Yes, as an adult
No, I have never owned a dog
If you have previously owned a dog, please tell us what happened to him/her?
Have you ever given any animal up for rehoming? *
No Yes
If, so please give details for the reason for rehoming? *
ADDITIONAL INFORMATION:
Please provide any further information you would like us to know about you and your home.
Are you prepared to put in the necessary time to help overcome any settling in issues/training that may occur?
No Yes
Please note you will be required to make at least 2-3 visits. Are you prepared to do this? *
No Yes
WHERE DID YOU HEAR ABOUT US?
How did you hear about us?
Please select an option that corresponds to how you heard about us?
Previously adopted
Friend
Already aware of the centre
Word of mouth
Llys Nini Website
RSPCA Website
Social Media Post
Other
We'd love to keep you updated about our fundraising activities, products and ways in which you can support us to help animals. Tell us how you would like to hear from us? (Please select all that apply) *
Declined
Email
Post
SMS
Phone
