Full name
Contact number
Email address
Household - Please outline the name and age of each person living in your household.
What are the hours worked per day of each adult in your household
Are you interested in meeting a particular dog?
Address where the pet will live
What sort of home do you live in?
Do you
If you are renting, do you have your landlord's permission to adopt a new pet?
What size is your backyard?
Is your yard completely and securely fenced, and what are the fences constructed from?
What shelter will the dog have access to?
Where will the dog be when you are not home, and on average how many hours per day will this be?
What percentage of the time will the dog be inside, compared to outside, when you are home?
How will the dog move between inside and outside the house?
Where will the dog sleep at night?
Please provide the breed, gender and age of each of your existing pets
Please outline whether or not each of your pets have up-to-date vaccinations, are microchipped and desexed.
Have you given away, surrendered, sold or otherwise rehomed a pet? Please provide information about this.
What mental stimulation will you provide for this dog?
What physical stimulation will you provide for this dog?
How will you approach socializing this dog so that it develops appropriate social behaviours when interacting with other dogs?
What would happen to this dog if you moved towns?
What would happen to this dog if you moved states?
What would happen to this dog if you moved overseas?
Which of the following behaviours would be 'deal-breakers' for a dog to remain part of your household?
Under what circumstances would you no longer be able to keep this dog?
How will you ensure you can financially care for your pet in case of a medical emergency?
Your personal vet contact details
Reference #1 name, relationship, contact number and email address
I declare the information included in this survey to be true, and understand that should I be successful in adopting a dog, this survey forms part of the adoption contract.
