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Your Name
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Address 1
Address 2
Address 3
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Town
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Post Code
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Home Telephone No
Mobile No
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Email Address
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PACT asks a minimum donation of £250 - £350, depending on age, to help cover costs of neutering, vaccinating, microchipping and health checks. Are you able to pay this?
Yes No *
Have you seen a specific dog on our website/Facebook? If so, who?
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What size dog are you looking for? If open to more than one, please comment below.
Tiny (chihuahua, mini yorkie etc) Small (Lhasa Apso, Jack Russell etc) Medium (Staffie, Collie etc) Large (Labrador, Lurcher etc) X Large (Mastiff, Great Dane etc) No specific size Multiple breeds
Are you looking for a specific breed? If so, please say.
Are there any breeds you DO NOT want?
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Are you looking for a single dog or would you consider a pair?
SIngle only Would consider a pair *
Would you be prepared to take on a dog with health issues? (all costs for treatment of existing conditions are covered by PACT)
Yes No *
What age range are you happy to adopt? Please check all that apply
Puppy - 1 year 1 year - 3 years 3 years - 7 years 7 years - 10 years 10 years + *
Have you ever had to give up an animal before? If yes, please explain. If no, write n/a
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What type of property do you live in?
House Bungalow Flat Mobile Home Barge/Boat House Other If Other, please specify
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Do you own or rent your home?
Own Rent *
If you rent your home, do you have the landlord's permission to adopt this dog?
Yes No Not applicable *
Please give details of your garden. Is it private or shared? What size is it? Is it secure?
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What is the height of your fencing at its lowest point?
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How many adults live in your household?
1 2 3 4 5 More than 5 *
Please give the ages of all the adults who live at the property
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How much time will you have each day to dedicate to your new dog? This includes exercise, grooming, training and general companionship.
If applicable, please give the ages of any children living in the property
Do children regularly visit your home?
Yes, at least once a week Yes, no more than a few times a year (birthdays, christmas etc) No *
How many hours in any one day would a dog be left?
Up to 1 hour Up to 2 hours Up to 3 hours Up to 4 hours Up to 5 hours More than 5 hours *
How many times a week would a dog be left for the time selected above?
1 day a week 2 days a week 3 days a week 4 days a week 5 days a week More than 5 days a week *
What other animals currently live in your house? Please include breed, sex and age of animals.
If you own other animals are they all spayed/neutered?
Yes No Not applicable *
If you've answered No to the above question, please give the reason why they are not neutered.
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Are all the animals you own inoculated annually and will you continue to inoculate the dog you want to adopt? You will be asked to provide proof your dogs are currently inoculated when you collect the dog. If your answer to this is No, please explain.
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Please tell us about your experience of owning dogs, including their breeds and what level of training you put into their care.
Are there any other dogs your new dog would come into contact with?
No, I am happy to avoid other dogs at all times. Only when out on walks but can try to avoid other dogs. I would like to socialise with other dogs. I regularly have other dogs in my home. I would like to be able to have other dogs visit my home. *
Are you prepared to take out insurance on your dog?
Yes No *
Is anyone in the household planning a baby in the near future?
Yes No *
How would you describe the environment in your home?
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Are you going on holiday or moving house in the next 6 months?
Yes, going on holiday Yes, moving house No *
Do you have reliable transport to take your dog(s) to the vets?
Yes No *
Do you feel you can comfortably afford a new dog?
Yes No Any other information we may need to know about you, what you are looking for or your circumstances that may help? Please tell us here or if you have filled this form out for someone else
