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Pre-Homing
Questionnaire - Please complete as much
as you can
IMPORTANT!
make sure your contact details in part
2 are complete so we can get in touch
with you. |
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Part
1 - Details of the Dog you wish to adopt |
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| Type/Breed |
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| if other, specify |
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| Sex |
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| Age |
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| Coat Type |
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Energy
Levels
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please select what would apply
to a dog suitable to your experience &
confidence |
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Training
Level
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please select what would apply
to a dog suitable to your experience &
confidence |
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| Additional
Info |
Use this area to tell us more
about your requirements. Remember, the more
information you give us, the better chance
we have of finding a suitable dog for you
to adopt. |
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Part
2 - All About You |
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| Name |
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| Address |
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| Postcode
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| Tel No
- Home (inc area code) |
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| Tel No
- Mobile |
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| Email Address |
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| You |
Your Partner |
| Age |
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Age |
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| Occupation |
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Occupation |
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| Working Hours |
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Working Hours |
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Hobbies &
Pastimes |
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Hobbies &
Pastimes |
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| Do you have transport |
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Do you have transport |
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Part
3 - Your Household |
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Tell
us about the other people in your household,
please include REGULAR visitors |
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| Relationship to you |
Age |
Allergies / special needs
/ important information |
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| Tell us
about the other animals and pets in your
home, include both indoor pets like cats
dogs etc., and also include outdoor livestock
such as sheep, pigs, horses, chickens etc.
please include REGULAR visitors. |
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| Type of home |
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| if other, specify |
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| Location |
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| if other, specify |
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| Is your home |
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| if other, specify |
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| Garden Details |
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| give details |
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| Is the
garden secure? i.e. is the access to the
garden well secured to prevent dog theft? |
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| What
is the height of your fence at its LOWEST
point? |
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| Do you
have a fish pond, swimming pool or any other
sizeable amount of water in your garden? |
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| Time at address |
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| If you have any plans to move
or change your property, please give details |
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Part
4 - General Questions |
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| What local
dog walking areas do you plan to use? |
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| How long
will the dog be left at any one time and
where will the dog be left while you are
out? |
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| Where will
the dog sleep at night? |
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| How do
you feel about dogs on furniture / beds? |
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| Do you
have a vets reference letter or a RSPCA
or other rescue home check form to hand? |
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Part
5 - Previous Dogs |
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| Have you
owned a dog before? |
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| What breed? |
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| What became
of it? |
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| Was the
dog vaccinated? |
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| Was the
dog micro chipped? |
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| Was the
dog insured? |
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| Was the
dog neutered? |
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use this area to notify us of any planned
changes to any of the above, and to give
any further information you think is relevant
in consideration of you adopting a rescue
dog |
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By clicking
'I AGREE' you confirm that you are submiting
your details for use by Fireside Rescue
and other associated rescues and have read
& understood our Terms
& Conditions of Adoption.
By clicking 'NO THANKS' you understand
that the whole form will be cleared and
your details WILL NOT be submitted to us
Please do not hesitate to contact us on
0870 777 92 94 if you have any problems
or if you need any further information. |
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