Dog Adoption Questionnaire

Your details

Your name:

Your address:

Postcode:

Telephone number:

Mobile number: (if different from above)

Email:

What are you looking for?

Use this space to tell us the name or names of dogs on our website that you are interested in, otherwise give us an idea of the breed or general type of dog you want to adopt.

Where you live

What type of property do you live in? Please select House Flat Other
If 'Flat', which floor do you live?'

If 'Other', please explain:

Owned or rented? Please select Owned Rented
If rented, do you have an agreement that allows a dog?  Yes    No
Does it have a garden?  Yes    No
Access to the garden, is it?Please select Private to you Communal
Is the garden secure?  Yes    No
Type of fencing:

Minimum height (include feet or metres in answer):

Are any there dangerous areas e.g Pond/Pool?  Yes    No
If yes, are they covered or enclosed?  Yes    No
Do your neighbours have dogs/cats?  Yes    No
If so, which pets and how many?

Will the dog have a kennel?  Yes    No

Looking after a dog

Is this your first dog?  Yes    No
How many people will be living with the dog?
Where will the dog sleep at night or when left alone?

Is anyone in the household pregnant?  Yes    No
Have you ever been refused a dog by another organisation?  Yes    No
Are you able to walk the dog daily?  Yes    No
If not, give details of how dog will be exercised:

Are you about to move or go on holiday?  Yes    No
If yes, when?

Are your work patterns liable to change?  Yes    No
How many hours will the dog be left in any one day?

How often?

Your household

Do you have any children?  Yes    No
If so, how many?
What are their ages?

Do any young children visit?  Yes    No
If so, how many?
What are their ages?

Does any member of the family have a pet related allergy?  Yes    No
Does any member of the family have any special needs that we should be made aware of?  Yes    No

Other pets

Do you have any other pets?  Yes    No
If so, what are they?

Are they fully vaccinated?  Yes    No
You will be required to produce a current vaccination card
Are they neutered?  Yes    No
It is our policy to seek confirmation from your Vet if needed.
Name of your Vet's practice

Can we approach your Vet for a reference?  Yes    No
If you are considering adopting a puppy from us we will require proof of registration of Puppy Training Classes before we will release the puppy to you.

Other information

Are you aware we have a neutering policy?  Yes    No
Are you aware Last Chance does not home bitches with bitches?  Yes    No
Are you aware of the costs involved in caring for a dog?  Yes    No
Do you know the cost of adopting from us?  Yes    No
Are you considering pet insurance?  Yes    No
Will you be taking the dog to training classes?  Yes    No
Do you know where they are held?  Yes    No
Do you have any objections to being home checked?  Yes    No
Which Veterinary Practice will you register your new pet with?

Why do you want a dog?

What would happen to the dog if you were unable to keep it?

Your privacy

We have a privacy policy on this website, you can find a link at the bottom of each page. If you click here the page will open in a new window, and you should be able to read it, close that window and return here.
Please tick the box to tell us that you have read and agree with the policy.

Finally

Enter the code from the image: 

Click below to submit your information, you will be given a chance to review and change what you have said.