Name of the dog you are interested in:Please enter the name of the dog(s) you are interested in

PrefixMr.Mrs.Ms.Mx.MissDr.Prof.

First Name

Last Name

Date of Birth *

Street Address *

City *

County

Postcode *

Home Phone *

Mobile Phone *

Email Address *

Would you like to receive the Rocky's Rescue newsletter? *Yes please, sign me up!No thanks, I'll opt out

Please give details of all other members of your household

Do you have a partner/spouse? *YesNo

Do you have children? *YesNo

First Name *

Last Name *

Date of Birth

Child Name

Date of birth

Child Name

Date of birth

Child Name

Date of birth

What type of home do you live in? *DetachedSemi-detachedTerracedFlat

What is your residential status? *HomeownerRentedLiving with parents

Do you have permission to keep pets? *YesNoWe will require a copy of the tenancy agreement clause allowing pets.

Does your home have a fully enclosed garden with walls/fences at a minimum 5 feet high?YesNo

If no, please give details of your garden area

Please give details of your household's employment status, occupation and hours worked

Your employment status *EmployedSelf-employedUnemployedStudentRetired

Your occupation *

Hours worked (daily) *

Your partner/spouse's employment status *EmployedSelf-employedUnemployedStudentRetired

Your occupation *

Hours worked (daily) *

How many hours a day would the dog be left alone?

Do you, or any member of your household, have any disabilities that could affect the standard of care given to the dog? *YesNo

Please give details below

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? *YesNo

Please give breed/size and any issued you had to overcome

Have you had any experience of dealing with the following issues:

Guarding *YesNo

Aggression *YesNo

Nipping/mouthing *YesNo

Reactivity *YesNo

Separation anxiety *YesNo

Pulling while walking on a lead *YesNo

House training *YesNo

Destructiveness *YesNo

Please describe your experience with this issue and how you dealt with it *

Will this be your first rescue dog? *YesNo

Have you ever had to find a new home or return a pet? *YesNo

Please give details of when, why and who the pets were rehomed to *

Do you have any other pets? Please select all that apply *DogCatRodent (Mice, Rats, Hamster etc)RabbitReptilesOther

Please give details below *

Please provide details of your current veterinary practice or the one you propose to use

Practice Name *

Address

City

County

Postcode

Are you happy for us to contact them in relation to your application *YesNo

What challenges do you anticipate in the first two weeks of your dog's arrival? *

Please tick the box to state you have read, understood and fully agree to our terms and conditions. *

Please take the time to read our terms and conditions

Would you be prepared to instruct a dog trainer/behaviourist to assist with training if needed? *YesNo

Do you know, or are you associated with anyone linked to Rocky's Rescue? *YesNo

Please give details below *

Is there any other information you feel would help with your application?

Submit

Our Charity

• Rocky’s Rescue.
• Registered in England & Wales
• Charity No. 1182726

 

Get In Touch

• Telephone: 07712 716 786
• Telephone: 07871 318 284

 

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• Complaints Procedure
• Privacy Policy
• Terms & Conditions
• Rehoming Policy

 

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