Pre-Adoption Questionnaire - Dogs | Homeless & Abused Animal Rescue Team

Name*
First Last
Phone Number*
Second Phone Number (optional)
Email*
Address where dog will be living*
Street Address Address Line 2 Suburb State Postcode
Driver's License Number*
Are you a permanent Australian Resident*
Are you adopting this dog on behalf of someone else?*
Please provide their full name, contact number, email & home address*
Your work type*
If you are enquiring after a particular advertised dog please provide their name and (if known) their HD number and why you think this dog would be suitable you you/your family/lifestyle etc:
What kind of dog are you looking to adopt:*
What kind of energy level are you looking for in a dog*
What level of grooming*
Any particular breed/mixes you like
What are the main characteristics you would like in a dog*
What are the least favourable characteristics you would like in a dog*
What activities would you enjoy doing with your dog*
Have you previously had pets in your adult life*
If 'yes' please provide details*
Do you currently own any other pets*
If 'yes' please provide details*
Are they desexed, microchipped and vaccinated*
If 'no' please provide reasons*
Who lives in your household and what are their ages*
Who will generally be responsible for the dog*
Is everybody in your household in agreement about getting a dog*
Is anybody in your household allergic to animals*
If 'yes' please provide detials*
Do you own or rent your home*
Do you have permission from your landlord/rental agent to keep a dog at your property (NOTE: you will need to provide written evidence)*
What description best fits your home*
Approximate yard size, fencing type and height*
Where will your dog be during the day*
Where will your dog be at night*
What will you do with your dog when you go on holiday*
Do you acknowledge that all dogs require daily food & water, shelter, basic vet care, routine flea and worming treatments*
Do you acknowledge that a dog can take time to settle into a new family/environment and will require love, patience and reassurance*
All HAART dogs are temperament tested/obedience trained to the best of our knowledge. Are you willing to undergo further training with your dog if needed*
Will you be taking out pet insurance*
Are you financially able to care for a dog*
Have you or anyone in your household ever been refused adoption with any rescue group, breeder or shelter*
If 'yes' please provide detials*
Have you or anyone in your household ever been convicted of animal cruelty*
If 'yes' please provide detials*
Have you or anyone in your household had to give away, rehome or return an animal*
If 'yes' please provide detials*
All adoptive families are to undergo a home & backyard check by one of our volunteers. Do you consent*
If you adopted and animal from us, would you be happy to provide occasional updates on how they are settling in with you*
Is there any other information you would like to add to your application
Please provide 2 references (friend, landlord, vet etc) that can provide a personal reference for your suitability to adopt an animal.
Please include their name, relationship to you, email and phone number.
Reference 1*
Reference 2*
To verify your identity, please attach a copy of your driver's license or, If preferred, we can view it in person at a later date. This information stays private.
By submitting this questionnaire, you agree that ALL the information provided is correct. You understand that providing untruthful or misleading answers, and a failure to comply with our requirements can result in the refusal of an adoption.
By submitting this application, you agree to allow our representative to contact the above references you have provided. You understand that a home check is required before an adoption can be finalised.
We reserve the right to refuse any applicant.
Consent*
I agree with the above statement and I agree that all provided information is current and correct.
Date*
DD slash MM slash YYYY
Driver's licence
Max. file size: 128 MB.
For driver's licence.

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