Adoption Form Name of the dog you are interested in adopting *0 / 1Contact DetailsApplicant First name *Surname *DOB *Street Address *City *County *Postal Code *Home PhoneMobile Phone *Email Address *Please select *I would like to receive the Rocky’s Rescue newsletterNo thanks, I will opt out of the newsletterPlease give details of all other members of your householdDo you have a partner/spouse? *YesNoDo you have a children? *YesNoSpouse/Partner name *DOB *Child *Age *ChildAgeChildAgeWhat type of home do you live in? *DetachedSemi-detachedTerracedFlatWhat is your residential status? *Owned homeRentedLive with parentsDo you have permission to keep pets? *YesNoWe will require a copy of the lease agreement clause allowing pets.Is your garden fully enclosed and secure? *YesNoAre the garden walls/fences a minimum of 5 feet high? *YesNoPlease give details of the household’s employment status, occupation and hours workedYour employment status *EmployedSelf EmployedUnemployedStudentRetiredOccupation *Average hours per day *Partner/Spouse employment status *EmployedSelf EmployedUnemployedStudentRetiredOccupation *Average hours per day *How many hours a day would the dog be left alone? *Do you or any household member have any disabilities that could potentially affect the standard of care given to the dog? *Why are you looking to adopt a dog? Please be honest and include as much information in the answer to this important question. *Have you owned dogs before? If so, please give breed/size and any issues you had to overcome. *Please describe your experience of dealing with the following issues:Guarding *Aggression *Nipping/mouthing *Reactivity *Separation anxiety *Pulling while walking on lead *House training *Destructiveness *Will this be your first rescue dog? *YesNoHave you ever had to find a new home or return a pet? *YesNoPlease give details of when, why and who the pets were rehomed to *Do you currently have any other pets? Select all that apply.DogCatRodent (mice, rats, hamster etc)RabbitReptilesOtherHas your dog(s) been spayed or neutered? *YesNoPlease provide us with the details of your current veterinary practice or the one you propose to use. *Are you happy for us to contact them in relation to your application? *YesNoWhat challenges do you anticipate in the first 2 weeks of your dog’s arrival? *Would you be prepared to instruct a dog trainer/ behaviourist to assist with training if needed? *YesNoDo you know, or are you associated, with anyone linked to Rocky’s Rescue? *YesNoPlease give details *Is there any other information you feel would help your application?Please take time to read our terms and conditions.Please tick the box to state you have read, understood and fully agree to our terms and conditions. Submit applicationPlease do not fill in this field.