Pound Puppy Rescue

Adoption Application Form

Please fill in as many boxes as you can.

Click on the Submit button at the bottom of the page when ready to send.

Types (breeds) of dog you are interested in:

Age range (puppy, young adult, adult, senior):

Todays Date:

Your name:

Address Street:

Town:

County:

Postcode:

Email address (required):

Home phone:

Work phone:

Best time to call:

Veterinarian's name:

Veterinarian's phone:

Veterinarian's town and county:

Your age:

Your spouse's age:

Do you own or rent:

Landlord's name:

Landlord's phone:

Would you accept a dog that has been abused?:

Who will be primary caregiver of dog?

Working hours of adults in home:

Size of garden:

List people living in house, ages, and relationship to adopter.

Current pets living in the house and their ages.

Current pets living outside and their ages.

Which current pets have been spayed or neutered?

Do you have a securely fenced garden? If so, how tall is fence.

Do children visit your home.

Are any members of household frail or sickly.

Where will pet be kept during the day??

Where will pet be kept at night??

Where will pet be kept when family is home?

Where will pet be kept when no one is home?

How many hours will the pet be left alone each day?

Will you accept a home visit?

List any characteristics of a dog that would not fit with your family or lifestyle.

Other information that you would like to include:

Types (breeds) of dog you are interested in:
Age range (puppy, young adult, adult, senior):
Todays Date:
Your name:
Address Street:
Town:
County:
Postcode:
Email address (required):
Home phone:
Work phone:
Best time to call:
Veterinarian's name:
Veterinarian's phone:
Veterinarian's town and county:
Your age:
Your spouse's age:
Do you own or rent:
Landlord's name:
Landlord's phone:
Would you accept a dog that has been abused?:
Who will be primary caregiver of dog?
Working hours of adults in home:
Size of garden: