Goodwill Rescue Limited Adoption Questionnaire

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Name

First

Last

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Layout

Phone

Date of Birth

Your Preferences

I would like to adopt the following dog if available?

Your Experience

I know how to train a dog to walk on lead? Yes or No.

How would you rate your dog experience? 0 no exp – 5 Highly Exp.

Your Household

I live with family/partner/alone/flatmates

Number of people in your household?

Do you have children under 18 years of age? How old are your children? (Some large breed dogs will not be foster ed with small children)

Have you experienced or are you currently being treated for any health issues including mental or physical health that may impact your capacity to perform the essential duties of caring for an animal? If yes please describe.

Your Home

I am a home owner or I rent. Please state.

If renting, is it is a condition of your lease that you can have a pet. Yes or No.

Do you have this written in the lease? Yes or No.

I have a balcony / courtyard / backyard / please state and please send photos to info@goodwillrescue.com.au

I live in an Apartment / House / Townhouse / Retirement Village (where pets are allowed)

Do you have a full fenced secure backyard? How high is the fencing? e.g. 1.8m or 6 ft, 1.5m or 5 ft? Please state and please send photos to info@goodwillrescue.com.au

Your Current Pets

I own a dog. What age, breed and gender? Are they dog friendly? Do they get along better with a female or male or both? Please send photos to info@goodwillrescue.com.au

Has your dog ever bitten a dog/person, shown aggression or protective behaviours? E.g. growling, lunging, nipping, barking at dogs/people? (It is your responsibility to declare any health or behaviour issues, your dog my have).

Is your dog desexed?

Is your dog vaccinated, and do you have a certificate? (It is your responsibility to declare this to GWR).

When was your dog last treated for flea/tick, worm/heartworm? Which brand do you use?

I own a cat. It is dog friendly, Yes or No.

How will you introduce your new dog to your own dog/cat?

Your Work

Are you retired? Yes or No?

Do you work F/T, P/T, Cas, Other (specify)?

How many days do you work from home?

If applicable, how many days does your partner/flatmate etc work from home?

How many hours are you out of the home each day? <2, 2-4, 4-6,6-8, 8-10 etc.

Your New Dog

I am able to walk my new dog each day for 20, 40, 60 minutes? Please state.

I know how to teach basic dog obedience like, sit, stay, come and heel. Yes or No.

My new dog will be mostly indoors, mostly outdoors, or both?*

I plan to feed by dog … please state a brand if possible of dry and wet food.

I think it is ok to feed a dog human food Yes/No

Do you have dog bowls, dog bed, lead, toys etc?

My new dog will sleep overnight in a crate, laundry, on my lounge, on my bed, outside?

When my new dog is outside there is shelter if it is very hot or raining. Yes/No

Would you be willing to drive 30-40 minute to the Vet we use for our animals if a desex contract is included?

Which vet will you use once you have adopted a dog?

If my dog needed to see the vet and you couldn’t afford it, what would you do?

Who would look after your new dog if there was an Emergency?

I have my own transport. Yes or No.

I have committed to adopt and care for GWR LTD dog/dogs and hereby swear and attest that the following information is true and will be followed to the best of my abilities concerning the adootion and care of the GWR LTDs pets:

I will not physically abuse, neglect, starve or harm the dog in any way.
I will make sure that the dog has enough food and water to maintain a healthy weight.
I will make sure that the pet has adequate shelter.
I will ensure that the pet gets the necessary requirement of daily exercise
I will never allow my dog to roam.
I will obey all laws concerning leashes and waste removal.
I agree that if I have a resident dog or cat that it is my responsibility to isolate them and integrate them slowly in line with the Dog Academy materials. This will likely require a crate or baby gate.
I agree that the 3 days to decompress, 3 weeks to learn routine and 3 months to settle guidelines will be fully understood and according time, space and patience applied

Plesse confirm your agreement with GWR by inserting Full Name and Date here

Please send photo of Driving Licence to GWR LTD
via info@goodwillrescue.com.au

Please state Driving Licence No / Name on Drivers Licence / Expiry date:

Thank you for taking the time to complete this questionnaire. We will be better able to match you to a dog with this detailed information.

Signature

Signature Date

Goodwill Rescue Limited

Goodwill Rescue Limited Adoption Questionnaire

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