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Lifestyle Match Form
Please note that all dogs available for adoption are brought in from Poland.
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Name
*
Surname
*
Are you applying to adopt a dog with another adult ?
*
Yes
No
Address Line 1
*
Address Line 2
Postcode
*
Town
*
Country
*
My area is considered to be:
*
City
Village / Small Town
Rural area
In a remote / isolated area
Other
Telephone Number
*
Email
*
Is your home rented?
*
Yes
No
Is your home a:
*
House
Ground Floor Flat
First floor or above flat
Boat
Caravan / Mobile
Other
If you have a garden is it:
*
Private
Communal or shared
I do not have a graden
How many people aged 17 and over live in your home?
*
How many people under 17 live in your home?
*
How often do you have visitors to your home?
*
Regularly
Occasionally
Rarely
What is the age group of the visitors?
*
Age under 5
Age between 6 – 11
Age between 12- 16
Age + 17
Is there anything else you would like to tell us about your visitors?
Do you currently own any other pets?
*
None
Dogs
Cats
Small Furries (rabbits , hamster etc)
Birds
Other
In the next three months are you planning an event that may impact any dog we rehome to you e.g. moving home, retirement or a holiday?
*
Yes
No
Is there anything else you would like to tell us about your home environment?
Are you able to take on a dog that has extra veterinary costs due to a medical condition? We'll explain any medical conditions and be upfront about the costs you could expect before you adopt.
*
Yes
Maybe
No
How often would you need to leave your dog alone in a normal week?
*
Never
Less than one per week
2-3 times
4-5 times
6 or more times
How long would that normally be for?
Up to 1 hour
More than 1 hour, up to 4 hours
More than 4 hours, up to 6 hours
More than 6 hours
Is this your first dog?
*
Yes
No
What size dog are you looking for?
*
No preference
Small (0-12kg)
Medium (12-25kg)
Large (26-45kg)
Giant (46kg+)
What age dog are you looking for?
*
No preference
Puppy (0-5 months)
Juvenile (6-11 months)
Young Adult (12-23 months)
Mature Adult (2-6 years)
Senior (7-11 years)
What gender dog are you looking for?
*
No preference
Male
Female
Are you looking for a specific breed(s) or are you open to any breed?
*
I’m open to most/any breed(s)
I’m looking for a specific breed
Tell us which breed(s) you are interested in:
Is there anything else you would like to tell us about the type of dog you think would suit you best?
Please provide any further information you would like to include in your application:
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