Adoption Applicaiton Step 1 of 2 50% Personal DetailsDate* First Name*Last Name*Address* Unit and or Street Number Street Name Suburb State Post Code Phone*Work or other Phone NumberEmail* Occupation*Full timePart timeStay at home MumCarerRetiredNot employedDriver Licence No. or ID Card No.*Municipality/Council*Pet Adoption DetailsDo you have an animal in mind? Or, would you prefer us to match a suitable pet?*I have a animal in mindPlease match me up with a suitable pet!Name of animal you are interested in Adopting?*Preferred Size of Dog*ToySmallMediumLargeIdeal coat type?*ShortMediumLongNon-sheddingIdeal personality?*Gentle Lap DogPlayfulOutgoing & SociableConfidentIndependentI would consider adopting two Dogs*YesNoPossiblyWould you consider adopting a Dog with Special Needs*YesNoMaybeWhat type of special needs dog would you consider?*Three Legged dogDeaf/blindEx Puppy Farm dogHave you owned special needs dogs before?*YesNoPlease give details*Do you have any Pets currently?*YesNoPlease give details of Pet type, age, sex, temperamentIs pet desexed?YesNoPlease give details*Is pet Vaccinated?*YesNoHave you owned Pets before?*YesNoPlease give details i.e. type, breed, how long you owned your pet, any other relevant information.How confident are you in caring for Dogs?Very ConfidentConfidentNot confident and would appreciate help to begin withHow many hours per day on average would your adopted Dog spend alone?Please give detailsAvailable time you have to exercise your Dog?5-7 days per week3-5 days per week1-2 days per weekNot at allWould you be prepared to housetrain if required?YesNoWould you be prepared to access training for your dog if required?YesNoPlease give details*If going on holidays what plans to you have for your dog?Boading KennelPet SitterStay with friendsOtherPlease give detailsWhat would you do if your dog exhibited behavioural issues?*Surrender to pound or shelterAccess training or assistanceConsult an animal behaviouristAsk Golden Oldies for help?I understand that older dogs may incur higher veterinary bills and I commit to providing the best Veterinary care availableYesNoPlease provide details*Do you or anyone in your household have any health, medical conditions or disabilities which would affect your ability to care for a dog?*YesNoPlease provide details*Dwelling detailsResidential details*HouseTownhouseUnitVillaOtherResidental Details - OtherDo you*OwnRentShareBoardIf Renting, please upload written Body Corporate, Strata or Landlord approval hereTime living at current premisesLess than a month1-6 months1-3 yearsOver 3 yearsIs your yard fully fenced with lockable gates?*YesNoOtherArrangements/Shelter available*IndoorOutdoorIndoor/OutdoorKennelCarportGarageLaundryFree access to all areaPlease give details?*This includes verandahs and balconiesAre there pools, spas, ponds, waterways or dams?YesNoPlease give details belowPlease include description of fencing already in place, is it Dog proof etc,.Is local traffic*QuietHeavyBusyOtherPlease give detailsCurrent Resident DetailsNumber of Adults living in the home?*Do you have children living at home?YesNoList ages of all children living at homeAre there known fur or dander allergies amongst residents?YesNoPlease give details*Is everyone in the home supportive of adopting a dog?*YesNoUnsureDo your neighbours have dog(s)*YesNoUnsureAre neighbouring dogs securely confined?*YesNoUnsure Have you or anyone in your household been convicted of Animal cruelty, neglect or had an animal removed from your care?*YesNoPlease provide details*Is there anything else you would like us to know?Please tell us more about your you, your family or your interest in Adopting a dog.Please provide the name and contact details of at least 2 referee's whom you have known for 2 years or more* By checking this box you agree to allow us to contact your referee's Referee No. 1 First Name Last Name Phone*Email Relationship to you i.e vet, employer, friendReferee No. 2 First Name Last Name Phone*Email Relationship to you i.e vet, employer, friendThis document is an expression of interest only. Completion of this document does not guarantee approval to adopt.*I understandYesNoI am over the age of 18 years*Legally you must over the age of 18 to adopt an animalYesNoDecisions on Adoption Application is final. We do our best to match the right dog to the right home, it is in no way an indication on your ability as a pet owner.*I understandYesNoAll succesful applicants are subject to a home inspection prior to the trial period*I understandYesNoOnce the home check is complete. A date for a two week trial period will be provided. During the trial period if Golden Oldies or you feel this is an unsuitable match, the animal is to be returned to Golden Oldies Animal Rescue. The animal remains the property of Golden Oldies until the Adoption is complete.*I understandYesNoAn adoption agreement and transfer of ownership will not be completed until adoption fees are paid and the trial period has finished.*I understandYesNoIf my adopted pet requires veterinary care I am willing and able to meet those costs. I commit to providing this care for the duration of my adopted pets lifetime (including but not limited to costs of food, yearly vaccinations, regular flea and worm treatments)* Agree Disagree I will never surrender my adopted pet to a pound or animal shelter. If I am unable to keep my adopted pet, I understand I am to contact Golden Oldies Animal Rescue first as Golden Oldies Animal Rescue adoptions offer lifetime support and care for all of our rescue animals* Agree Disagree I have not provided false information. All information supplied is true and correct and in no way misleading.* Agree Disagree Date* Name* First Last You may be asked to sign this form at a later date in the process. We will be in touch very soon!CommentsThis field is for validation purposes and should be left unchanged.