Deaf Dogs Rescue Australia form

Dogs name you are applying for

Type the dogs name

How did you hear about us?

E-mail*

Full Name*

First NameLast Name

Age

Address*

Street Address

Street Address Line 2

CityState / Province

Postal CodeCountry

Phone Number - Home

Area CodePhone Number

Phone Number - Mobile

Phone Number

Phone Number - Work

Area CodePhone Number

Do you live in a:

Do you:

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Household Setting

RuralSuburban

Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?

YesNo

Please List any Pets you have Living (Please include Name, Breed, Age, desexed, Sex, Vaccines, Heart worm, *

If you own a dog. Is your dog trained? How excepting is your dog to bring a new dog into the family?

Male or Female

MaleFemale

Dogs Name you are applying for?*

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?

YesNo

Dog your applying for

Do you work?

Where do you work?

How many hours do you work?

Have you had any experience with with an emotionally or physically neglected or abused dog, Deaf or blind dogs.

YesNo

Need to add anything to make your application stronger?

Do you have a fenced yard?

YesNoPartialProvide photo

Photo of property

Browse Files

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

Do you agree to keep the dog safe from harm? When out walking the dog is to be kept on a lead. Whilst on your property the dog can not get out of fencing or property.

Please describe where the dog /puppy you are applying for will sleep?

Please list 2 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?

YesNoFostered for previous rescueOther

Vet Reference: Full Name: if you do not have a pet at the moment just put your own details in here*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal CodeCountry

Phone Number*

Area Code +61Mobile

Second Contact #Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState

Postal CodeCountry

Phone Number

Area CodePhone Number

Phone Number

Area CodePhone Number

Signature*

Date

MonthDayYear

Your name*

E-mail

Please read the form clearly

Bank details are on the form.

Deaf Dogs Rescue Australia

Bank: police bank

BSB: 815000

acc: 292246

You must pay the adoption fee before taking the dog. If the adoption does not work for any reason you have 20 days for a refund less $100 admin fee.

You agree that you will not surrender or give your dog to anyone that is not on our legal paperwork.

If you ever find your situation changes and you can no longer keep your dog that you adopted from us. Please contact us so we can help.

You are responsible to complete your local council registration form. We transfer the microchip into your name on the microchip webpage at our cost.

Tick the name of the dog you are applying for

Blue $495Other