Name:
Address:
Telephone number:
Mobile number:
E-mail address:
Time at present address:	<1 1 2 3 4 5 6 7 8 9 10 >10 <Please Select>  years
Ownership:	Owned Rented <Please Select>
If rented written permission from the letting agency allowing you to keep pets will be required
Number of family members:	1 2 3 4 5 6 7 8 >8 <Please Select>
Ages of all family members living at or regularly visiting the home if under sixteen years of age:
Are family or visiting children used to living with dogs	Yes No <Please Select>
Occupation:
Hours worked away from home per day:	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 >16 <Please Select>
Is your home:	Detached House Semi-Detached House Mid-Terrace House Flat (Private Garden) Flat (Communal Garden) Flat (No Garden) Other (Please Specify) <Please Select>
	(other)
Do you live in a:	City/Urban Area Suburban Area Rural Area <Please Select>
Do you have a fully enclosed garden?	Yes No I do not have a garden <Please Select>
Is your garden completely secure?	Yes No I do not have a garden <Please Select>
How high is fencing at lowest point?
Family experience of pet ownership and responsibility
What other family pets share your home?
If you already have dogs, what breeds are they?
What previous dogs have shared your home?
Have you previously adopted a rescue dog?	Yes No <Please Select>
What happened to the previous dog(s)?
Are all current family dogs neutered/spayed?	Yes No Not Applicable <Please Select>
Are current family pets used to mixing with other dogs?	Yes No Not Applicable <Please Select>
If already registered with a vet, please give their details
Vet's name:
Vet's address:
Vet's telephone number:
May we contact your vet for a reference?	Yes No Not Applicable <Please Select>
Dogs details - your preferences
What gender would you prefer?	Male Female Either <Please Select>
Age of dog(s) you would consider for adoption?
Size of dog(s) you would consider for adoption?
What food to you intend to feed your dog(s)?
Are you prepared to have your dog(s) spayed or neutered?	Yes No <Please Select>
Are you prepared to have your dog(s) vaccinated?	Yes No <Please Select>
Are you prepared to insure your dog(s)?	Yes No <Please Select>
Are your prepared to seek medical attention for your dog(s) from a registered vet if needed and ensure flea and worm treatments are administered at regular intervals?	Yes No <Please Select>
Are you aware of the financial obligations of responsible pet ownership?	Yes No <Please Select>
Do any of your family members suffer from allergies (if so please specify)?
Would you be attending training classes with your dog(s)?	Yes No <Please Select>
Apart from being a family pet, are you considering a dog for: (hold down Ctrl to select more than one)	<Please Select> Agility Flyball Obedience Working Trials Showing
Where would your dog sleep
How would you cope with:
Toilet training
separation anxiety
destructive behaviour
Basic obedience training (sit, stay, etc)
Fearfulness
Aggression
Under what circumstances would you consider returning the dog(s) to Mill Rescue?

Please be aware

All dog(s) adopted from Mill Rescue are done so by both parties entering in to a legally binding adoptive agreement should, at any time in the future, abuse or mistreatment of any Mill Rescue dog be suspected, Mill Rescue regain the right to remove any dog(s) from its adoptive home without notice.

Mill Rescue:

A) agrees to make you aware of any known behavioural issues or medical problems of any dog you wish to adopt.
B) will endeavour to offer any support needed to assist your dog(s) become a valid member of your family.
C) will, in the event of you needing to rehome your dog(s) accept any dog(s) adopted from Mill Rescue, once kennel space is available.

Those adopting Mill Rescue dog(s) will be expected to:

1) treat the dog as a valid member of the family.
2) neuter any dog(s) on adoption or at a suitable age agreed by a vet and show Mill Rescue proof of this procedure once completed.
3) never breed from any Mill Rescue dog(s).
4) ensure dog(s) have vaccinations, regular flea and worm treatments and be offered medical attention from a registered vet when needed.
5) be exercised daily in a way that meets the needs of the dog(s) age and breed.
6) be groomed on a regular basis(we are always on hand to give advice where needed)
7) not be left alone for any extended periods of time.
8) not be rehomed to a third party at any time.
9) inform Mill Rescue of any change of permanent address at which the dog shall be living.
10) ensure the dog(s) wears a suitable collar and identification tag at all times.
11) inform Mill Rescue in the event of the dog(s) becoming missing/lost/stolen.

I have read and accept the above conditions of being considered to adopt a Mill Rescue dog(s) and understand by checking this check-box that I agree to be bound by them.

 

Thank you for considering adopting a Mill Rescue dog!