Pre-adoption questionnaire

Last Page

A few details about you

Title (Required field)

Mrs

Miss

Other

First Name (Required field)

Surname (Required field)

Date of Birth (Required field)

DD/MM/YYYY PLEASE NOTE YOU MUST BE 18+ TO APPLY

Address (Required field)

Postcode (Required field)

Telephone number (Required field)

Email address

Alternative telephone number

(We will usually contact you between the hours of 8:30am and 4:30pm)

Please check you have completed all of the required fields.

You are interested in:

Size of dog:

Small (e.g. Terrier)

Medium (e.g. Staffie)

Large (e.g. Labrador)

Any

Gender of dog:

Male

Female

Either

Age of dog:

Puppy

Less than 2 years

2-5 years

5-8 years

8 years +

Any

Is there a dog or puppy on our website that you are interested in? (Required field)

(You can add more than 1 dog by clicking the button above multiple times).

At which centre is the dog or puppy you are interested in? (Required field)

Birmingham

Wolverhampton

A little bit about your home:

Do you (Required field)

Own

Rent

If you rent, do you have written permission to have a dog in the home? (Required field)

Yes

N/A

Type of property (Required field)

House

Bungalow

Flat

Other

If other, please specify

If you live in a flat, which floor is your flat on?

Do you have a garden? (Required field)

Yes

Communal

Size of garden (Required field)

Small

Medium

Large

N/A

Is the garden all secure? (Required field)

Yes

Height of fencing: (Required field)

Under 4ft

4ft

5ft

6ft +

No fencing

Do you have direct access into your garden? (e.g. via a door or gate?) (Required field)

Yes

If no, please specify:

Please check you have completed all of the required fields.

A little bit about your family:

Who lives at home?

Number of adults: (Required field)

Number of children (if no children, please type n/a in the box): (Required field)

Ages of children:

Do you have children that visit regularly? (Required field)

Yes

If yes, what are their ages?

Frequency of visits: (Required field)

Daily

Weekly

Monthly

Annually

N/A

Do you own any other dogs? (Required field)

Yes

If yes, please state breed and gender

Are they neutered? (Required field)

Yes

N/A

Do you have any other pets? (Required field)

Yes

If yes, tick all that apply (Required field)

Cats

Rodents

Pet birds

Rabbits

Other

N/A

If other, please state:

Do you have any visiting animals (e.g. family/friends' cats and dogs)? If so, please give details: (Required field)

Please check you have completed all of the required fields.

A little bit about your lifestyle:

How much daily exercise do you expect to give the dog?

Weekday (Required field)

Weekend (Required field)

How active are you? (Required field)

Very

Reasonably

Not very

How long do you expect to leave the dog alone on a regular basis? (Required field)

When? (Required field)

Daytime

Evenings

N/A

How often?

Where do you plan on leaving the dog when you leave the house? (Required field)

Kitchen

Lounge

Run of house

Other

If other, please specify:

Are you planning on any of the following? (Required field)

Moving house

Holiday in the next few weeks

Planning a family

N/A

Your ideal dog would:

Be good with cats (Required field)

Very important

Quite important

Not important

Like other dogs (Required field)

Very important

Quite important

Not important

Be good with livestock (Required field)

Very important

Quite important

Not important

Be comfortable around children (Required field)

Very important

Quite important

Not important

Like strangers (Required field)

Very important

Quite important

Not important

Enjoy being picked up/petted (Required field)

Very important

Quite important

Not important

Please check you have completed all of the required fields.

Previous ownership experience

Have you had dogs before? (Required field)

Yes

If yes, can you give details (i.e. Breed, Size, Gender etc.):

Please tell us a little more of your experience: (Tick any that apply) (Required field)

I need a dog that has already been trained

This will be my first dog

I have trained pet dogs before

I would enjoy training a dog

I am an experienced owner and could train a difficult dog

By submitting this form, you agree that all the information above is factual and truthful to the best of your knowledge.

I agree

Whilst every care is taken to find the right dog for you, we cannot guarantee behaviour.

Thank you so much for your enquiry. We would really like to keep in touch with you so we can keep you updated about our work, information about adoption and information about supporting our charity. Please select your preference below and remember you can change your mind at any time – just let us know.

First Name

Last Name

How would you like to hear from us?

Telephone

Post

Your privacy is important to us.

The information you provide to Birmingham Dogs Home will be treated confidentially and only used in line with your instructions on this form. We promised to protect your data and manage any data you share with us in line with all current data protection laws. Your details will not be passed on to any third parties. If you change your mind or do not wish us to contact you further, please let us know at communications@birminghamdogshome.org.uk.

Thank you

A few details about you

You are interested in:

A little bit about your home:

A little bit about your family:

A little bit about your lifestyle:

Your ideal dog would:

Previous ownership experience

Your privacy is important to us.

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