Application to adopt

(Please check the applicable box) Participation in our Pet adoption re homing program incurs a ONCE ONLY contribution fee towards ongoing Pet rescues *

I want to participate, adopt a pet and pay a $150 contribution fee for a CAT

I want to participate, adopt a pet and pay a $200 contribution fee for a DOG

(Optional) If you have any questions about the fee, Put them here, we'll answer, when we respond to your application. OR Leve Blank

First Name *

Last Name *

Please enter your (Primary Email Address) *

Street number *

Street Name *

Town or Suburb *

Post code *

Home Phone (necessary) Can be a Landline or Mobile number *

Mobile Phone (optional)

Please Check the boxes that apply ( IF ) you have other pets

If your type of Pet is not listed above feel free to mention it here (optional)

Where you live - Are you Renting or Buying *

BUYING the property I live in

RENTING the property I live in

Renting Now & in Process of Buying

Building a House?- Feel free to mention anything you like about accommodation for a Pet here (optional)

( IF ) you are Renting (WE NEED) a letter from the Landlord/Agent stating Pets are allowed, can you provide this

Yes Pets are allowed I can provide an official letter (not a copy)

I am in the process of asking if I can have a Pet and will provide an official letter (not a copy)

I am not sure if Pets are allowed where I live

I do not intend telling the agent or landlord

Pets are not allowed where I live - I'll take my chances

( IF ) you are Renting additional information about Landlord/Agent letter can be mentioned here (optional)

Is the property where you live fenced *

How will you keep the Pet off the streets, out of the pound and safe?

If you wish to include more information about property fences, please use this box below (optional)

If you have NO pets now and HAVE had Pets before, Please tell us what happened to them OR why you no longer have them

If you DO have pets now, when was the last time you visited your Vet - What was the visit to the Vet about ?

If you DO have pets, where do you take them to see a Vet

If you have Pets OR intend having Pets - Question Applies only to (Cats or Dogs) Please Check boxes that apply *

My Pets always live strictly outside

My Pets always live strictly inside

My Pets mostly live outside and come in at night

My Pets mostly live inside and go out at night

My Pets are outside while I'm at work

My Pets live inside and go outside when they wish

What are your views on house pets? This question is referring to cats and dogs (optional)

( If ) you have Children, what are their current ages? This (optional) question helps us match Pets and Owners

Please check all boxes that indicate your Pet adoption preferences

Young Cat

Older Cat

Young Dog

Older Dog

Small Dog (Jack Russell Terrier or smaller Size)

Medium Dog (Kelpie/Staffy Size)

Large Dog (Labrador/German Shepherd Size)

Very Large or Tall Dog (Grey Hound/Great Dane Size)

If you have any concerns about shape or size! mention it here (optional)

Check any box that applies to you (optional question) - We ask this question because sometimes we have Pets with special needs

I can help & love any Cat with Special needs ( extra vet care or medications)

I can help & love any Dog with Special needs ( extra vet care or medications)

I prefer not to adopt a pet with special needs

I have time for pet, however my circumstances are not suited to a special needs pet

My work commitments prevent me from dedicating time to a special needs pet

Sometimes we have Pets in our re homing program that have been badly injured, abused, or may have had corrective surgery for any number of reasons. Occasionally there may be circumstances where a Pet may recover from past traumas in a permanent loving family home environment, where they will continue visits to us, receive veterinary treatment and or further surgery until fully recovered. In other cases a Pet may need medication and periodical check-up examinations for the rest of their lives.

If you wish to add additional information about anything, please use the message box below (optional)

Optional Question - APPLICABLE TO SPECIAL NEEDS PETS (as above) If we have a Pet for adoption that meets the circumstantial criteria above, that needs continued Veterinary treatment, It is a MANDATORY CONDITION that the Pet comes back to Hanly Veterinary Clinic and Hospital to receive ongoing Veterinary treatment until fully recovered. Please state your views if you have any

APPLICABLE TO SPECIAL NEEDS PETS (as above) I will comply with the MANDATORY CONDITION that the Pet comes back to Hanly Veterinary Clinic and Hospital to receive ongoing Veterinary treatment until fully recovered.

I agree and will comply regarding A Special needs Pet

I agree and will comply with any unusual medical needs for rare circumstances not mentioned here, for the wellbeing of a Special needs Pet.

Feel free to ask questions or mention anything you'd like us to know about Pet adoption

Please check 3 boxes to agree - I state that I am an adult and over the age of 18 Years as of the Date below, and any information I have provided in this form is true and correct. *

The information I have provided in the form is true and correct

I am an adult over the age of 18 Years

I am very sure I want to adopt a Pet

I am still considering adopting a Pet

I am thinking of adopting a pet for somebody else

Please Digitally SIGN - By typing your Full Name including Middle Name *

Please type the Date you signed this form *

Thank you for your interest in our Pet adoption/re homing program, we believe like you, that Pets falling victim to sad and unfortunate circumstances deserve the life that nature intended in a healthy, happy and safe environment, as is our philosophy "May all creatures be happy and free from suffering"

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