Expression of interest Application

This form is an expression of interest form only and does not form any legal binding contract. Your application will be looked at by a member of staff and if the criteria are met for the dog you have selected then we will be in contact with you shortly to arrange a viewing appointment. We will only be in contact with those selected for an appointment.

Animal you are interested in adopting *	Brodie (Dog - WL120)
Breed experience * Please indicate if you have any experience with the breed of dog you are applying for	NoYes
Applicant's First Name *
Applicant's Last Name *
Street Address *
Town *
County
Postcode *
Phone Number Please use the following format 248-555-1212
Email Address * Please enter correctly as this is the main way we will contact you
Mobile Number *
Date of Birth
How did you find out about us?	Internet Search Family/Friend Staff/Volunteer Facebook/Twitter Other
Have you applied anywhere else for a pet?	NoYes
If yes, where else have you applied for a pet?
Is this pet for you or someone else?	Myself Someone else
Do you own other pets at the current time?	NoYes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?	Yes No N/A
How many pets have you owned in the last 5-10 years?
What happened to them?
Are your pets current on their vaccinations?	Yes no n/a
Have you ever surrendered a dog into a shelter?	NoYes
If yes, please explain?
Veterinarian's Name If you have never owned a pet please tell us where you would go.
Veterinarian's Address, Town, County, and Postode Again if you have never owned a pet please list where you would go
Veterinarian's Phone Number
Have you ever had a pet euthanized?	NoYes
If yes, please explain:
If you have pets, will they adjust to a new pet in the house?	Yes No Unsure N/A
If you answered "other" above, please explain here:
Please describe in detail the pet you are looking for.
Do you own or rent your home?	Own Rent Someone else owns the Home Someone else rents the Home
Landlord contact number * If you rent your property, please supply contact details of your Landlords/or Housing Association
Please select your current residence type.	House Apartment Condo Townhouse Mobile Home Other
If you answered "other" above, please explain here:
How long have you lived at this address?	Less than one month 1-2 months 3-6 months 6-9 months 9-12 months 1-2 years 3-5 years 6-10 years 10 + years
If you rent, does your landlord and lease allow pets?	Yes No Unsure N/A
Including yourself, how many people live in your household?
Please list the ages & relationship of those who live in your home.
Is everyone in your household aware that you are planning to adopt a pet?	Yes No N/A
Does anyone in your household have allergies to dogs?	Yes No Possibly N/A
Employment Status	Full-Time Part-Time Retired Work from Home Stay at Home Parent Student Unemployed Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation?
On average, how many hours per day will your pet be left alone?
Will this pet be predominantly living inside, outside, or both?	Inside Outside Both
Please provide a description of this pet's living conditions.
Do you have a completely fenced-in yard? If so, what kind of fence?	Wood Chain Link Electric Plastic Iron Other Other (I do not have a fenced yard)
If you answered "other" above, please explain:
Where will the animal sleep?	In bed with me In a dog / cat bed In a kennel / crate Wherever he or she likes Outside Other
If you answered "other" above, please explain:
If you answered "other" above, please explain:
How will you handle house training?
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations?	NoYes
If no, please explain:
Are you willing and able to exercise the dog on a regular basis?	Yes No N/A
If yes, what is the method of exercise?	Walking Running Dog Park / Dog Run Other
If you answered "other" above, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?	NoYes
If yes, please explain:
What arrangements will you make for the care of your pets in case of an emergency?	Leave with family/friend Boarding Pet Sitter Take with me/us Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?	Leave with family/friend Boarding Pet sitter Take with me/us Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
What would you do with your animal if you had to move?	Take him / her with me Give to family or friend Return to shelter Other
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?	NoYes
If no, please explain:
Will you allow us to perform home checks?	NoYes
Additional Comments
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal.	Yes No
Signature	Clear