A FEW DETAILS ABOUT YOU
Title
Mr Mrs Miss Ms Other
First name *
Surname *
Address *
Town
Postcode *
County
Best telephone number to contact you on *
Email address *
Can you confirm that the application and contact information given is that of the person looking to adopt, or on behalf of someone else? *
If you are applying on behalf of someone else, please detail who the person is to you and why
Can you confirm that you are over 18 years of age? *
No Yes
Can you confirm that everyone one in your household is aware of you filling in this form to apply to adopt a dog and that no one has any reservations or allergies? *
No Yes
Can you confirm that you and no other member of your household, has an unspent conviction for offences relating to animals *
No Yes
WHERE DID YOU HEAR ABOUT US?
Please advise how you heard about RSPCA Worcester & Mid-Worcs Branch
Facebook/social media
Already aware of centre/branch
Website
Word of mouth
Just passing
NCC/RSPCA enquiries
Other
YOU ARE INTERESTED IN
Adopting or fostering *
Adopting
Fostering
If you are interested in a specific dog, please tell us their name *
Are you looking for a specific breed? or could you describe what sort of dog/breed you are looking for *
Is there a breed of dog you would not consider rehoming?
Size of dog *
Small (e.g. terrier)
Medium (e.g. Staffie)
Large (e.g. Labrador)
Any
Age of dog *
Puppy
Less than 2 years
2-5 years
5-8 years
8+ years
Any
Gender of dog *
Male
Female
Either
Please let us know why you are interested in adopting this or any dog and what makes them suitable to your home? *
A LITTLE BIT ABOUT YOUR HOME
Do you own or rent your home? *
Own
Rent
If you rent, have you got written permission from your landlord?
No Yes
What type of home do you have? *
House
Bungalow
Flat
Ground floor flat
Mobile Home
Other
Do you have a garden? *
Yes
No
Communal
If yes, what size garden do you have?
Small
medium
Large
Very large
Is the garden secure from escape? *
Please provide details of provisions to prevent escape (e.g. fencing, what size and type you have or if the dog won't be let out unsupervised etc) *
A LITTLE BIT ABOUT YOUR FAMILY
Including yourself, how many adults live in your home? *
1
2
3
4
5+
How many children live in your home? *
0
1
2
3
4
5
6+
If children live in your home, please state their age(s)
Any visiting children? *
No Yes
If yes, please state children's age(s)
Frequency of visits
Daily
Weekly
Monthly
Annually
Do you own other dogs? *
No Yes
If yes, please state their age, gender and personality of your dog(s) and how they react to other dogs in the home or out and about
Are they neutered?
No Yes
Are they vaccinated?
No Yes
Do you own other pets? *
No
Cats
Rabbits
Rodents
Pet birds
Other
Do you have any visiting animals (e.g. family/friends' cats and dogs)? If so, please give details
A LITTLE BIT ABOUT YOUR LIFESTYLE
How much daily exercise do you expect to give the dog (No of hours weekdays)? *
(No of hours weekends)? *
How active are you? *
Very
Reasonably
Not very
How long do you expect to leave the dog alone on a regular basis? *
Is this:
Daytime
Evening
Night time
How often?
Please describe what provisions you will have in place to help with the dogs care if you have to be out for long periods of time (over 4 hours).
How much exercise will you be able to give a dog on a typical weekday? *
How much exercise will you be able to give a dog on a typical weekend day?
Are you planning any of the following? *
Moving house
Holiday in the next few weeks
None of the above
If yes to any of the above, please give us some details of these plans
Please provide details of anything that may prolong the rehoming process (eg. house renovations, hospital stays, work commitments etc) *
Please briefly describe a typical day in your household and how a dog might fit into it? (including walks etc) *
What hobbies or activities would like to or envisage including a dog in?
YOUR IDEAL DOG WOULD:
Be good with cats *
Very important
Quite important
Not important
Like other dogs *
Very important
Quite important
Not important
Be good with livestock *
Very important
Quite important
Not important
Be comfortable around children *
Very important
Quite important
Not important
Like strangers *
Very important
Quite important
Not important
Be housetrained *
Very important
Quite important
Not important
Enjoy being handled/petted *
Very important
Quite important
Not important
Like travelling in the car *
Very important
Quite important
Not important
YOUR EXPERIENCE
Have you owned a dog before? *
No Yes
If yes, please state what the dog (or dogs) breed, sex and what happened to them
I need a dog that has already been trained *
No Yes
I have trained pet dogs before *
No Yes
I would enjoy training a dog *
No Yes
I am an experienced owner and could train a difficult dog *
No Yes
Are you currently registered with a veterinary surgery? *
No Yes
If yes, what is the veterinary surgery's Name and are you happy for us to contact them for a reference if required?
Signature *
Clear
Date *
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