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Melbourne Dog Rescue Inc. (A049467Y) - Adoption Application Form

Personal Details *First Name *Last Name Street Address *Suburb Post Code *Home Phone Number Work Phone Number Mobile *Email

People living at the premises:

How many adults?

1 2 3 more

How many children?

none 1 2
3 more
How old is/are the Child/Children?

Identification

Drivers Licence or Passport Number (Will need to sight):

*fields with an asterisk are required

Questionnaire Why do you want to adopt a dog? Do you currently have any pets? If so, what kind? Do your present pets (if any) have any behaviour or socialization problems? If so, please explain: Where will your new dog sleep? Have you had any pets in the past? What happened to them? Have you ever taken an animal to a shelter or released it to another party? If yes, please explain: Does anyone in your house not want a new dog? If so, please explain: Please explain who will be the main caretaker of this pet: Have you been refused an adoption with any other breeder, rescue group or shelter? If so, please explain: To your knowledge, is anyone in our family allergic to animals? If yes, please explain: Is your yard securely fenced? If no one is home, where will the dog stay? How many hours will the dog be left alone for each day? Will the dog be allowed inside? How much of the time? Do you agree to return the pet to us should your circumstances change or the adoption not work out? Do you have a swimming pool? If yes, will the dog be separately fenced away from the pool? What will you do with your pet if you have to go out of town or move? Does your job require you to move or travel often? Please explain: If you are renting, please provide us with your landlords name and phone number for confirmation: How do you plan on ensuring the dog’s safety outdoors? What will you do if this pet has or develops behaviour problems? Under what circumstance would you give up this pet? (E.g. Family illness, barking or digging, high cost vet bills) Realising that dogs often live 15 years or older, are you willing to take responsibility for your pet’s entire life, keeping it current on yearly vaccinations and tests? Realising that dogs often live 15 years or older, are you willing to take responsibility for your pet’s entire life, keeping it current on yearly vaccinations and tests? List medical care you would provide and how often you would provide it: What will you do if this pet becomes ill or injured and requires expensive medical care? What will you do if your pet becomes lost? Is there anything else you would like to tell us about you, your family or your interest in adopting a dog? Do you currently have a vet? If so, please provide us their name and phone number so we can contact them for a reference: If you do not have a vet, please provide the names and phone numbers of three personal references: Do you give your consent for this information to be shared with other rescue organizations for the purposes of finding a suitable dog for you to adopt?

Before you submit please read this carefully:

By submitting this application, I agree that all the information I have provided is correct. Providing untruthful answers or failure to comply with the requirements of this application or the signed adoption contract can result in the forfeiture of the adoption.

You agree to allow us to check the references provided. We will require the successful applicant to sign an adoption agreement and allow a yard check before adoption.

We appreciate you taking the time to complete this application. Upon review and approval, we will contact you.

We reserve the right to refuse any applicant!

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