If you are looking at getting a rescue to join your family please copy & paste the following form into an email and send it to [email protected]

                  Adoption application form

                                                                                   Date :

Name/s :

Address :

Phone :                                                                Cellphone :

Occupation :                                                                    Age : 

 ( if on a Sickness benefit or similar what for ) ( Must be over  18 yrs )

Nationality /Ethnic group :

                                      Household Information

Do you live in your own  home / rental / rural ?

How long have you lived at this address?

Do you live with a relative?                                                                               

Does your landlord allow  dogs ?                                                                      ( please attach written approval from landlord )

What is the name and telephone number of your landlord ?

Are you planning to move soon?

Do you have a fenced yard preferably with 6 foot fencing ?

Did you want a male or female ?

( if applying for an advertised Rescue if so please name)

                                   Family Information

Number of adults in household: ______  

  Number home during the Day _____

Number of children in household:________         

 Ages of children ________

 Who will be primarily responsible for the care of your new pet?

Is anyone in your household allergic to animals?                                            

How frequently do you have to make business/vacation trips?

What provisions will you make for your animal at these times?

Do you reside at more than one address ?                                               

If yes does this address have adequate fencing for a Large breed dog ?                                         

How often would the dog reside at this address ?

Are you happy for us to do a property inspection of the other address you reside at ?                                        

If yes please provide address :

                                       About Your Interest

Why are you interested in adopting a rescue dog ?

 Do you have experience with this breed or large breeds ? (explain)

Have  you ever adopted a pet from a rescue organisation before ?   

If so, who & when

Do you still have this pet?                                                                              

   If not, why ?

Are you aware of the health issues effecting this breed ?                       

 If yes what are they :

How would you describe your lifestyle ? (example : very Busy )

Would the dog have free access inside your home ?                                          

Previous/Current Pet Information:

Have you had any other pets in the past ten years?                                

 What happened to them?

                     Number of animals currently in household

(dogs) ________ (cats )_______________(stock )________

( Other ) _________________

Are your household pets all neutered / spayed ?

Where will the dog be kept during the day ?

 At night ?

                          Animal Health Information

Name of Veterinarian Clinic:

Do we have your written consent  to obtain past Vet Records/Reference if required ?   

General, non-emergency medical care can run around $400 for a healthy pet per year.   Emergency care can be far more costly being a large breed. These costs do not include food, toys, grooming, etc. Are you able to commit to these resources for the annual & emergency  medical care of a companion pet?     


How long have you been with this veterinarian ?

( If only a short time name of previous veterinarian  )  

                      Adoption Is A Life-Long Commitment

Adopting a companion animal is a great responsibility. You will be sharing your life with a pet for up to 6-10 years who is totally dependent upon you for food, shelter, clean up, veterinary care and lots of love. Are you willing and able to make this lifelong commitment?                                                                                 

Are you willing to make the commitment to seek advice or training to resolve any  behavioural or medical concerns with your pet?        


Have you or anyone in your family or household been accused or charged with a violent crime ?                             


Will you insure that your dog is registered with your local council and be a responsible dog owner as required by your local council bylaws  and keep the dog under control at all times?           


Have you or anybody in your family / household ever been charged with or been accused of animal cruelty /neglect?                                                                                             

You do realise that some rescue dogs need a little extra work and are you prepared to do this ?

Personal reference, please do not use family members or partner . How long known ?




Do all household members want to have a new adopted pet?    

Any other info you feel maybe helpful ?

We reserve the right for an authorized representative to make random and unannounced visits to assure adoptions are going well. Is that acceptable to you?  

I, ........................................................... certify and   affirm that the information     contained herein is true and correct, and that I am not less than 18 years of age 

 Signature of Applicant :______________________________

NB : All information provided will not be forwarded to any third party and will be kept within the Rescue committee..

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