Find a Dog

Name:

Postal Address:

Phone (home):

Phone (work):

Phone (mobile):

Email:

Please describe the special need of the special person who would benefit from having a Special Dog:

Do you reside with children?:
Yes
No

If yes please give their ages::

What sort of dog would you like?:
(mini) 2-4kg
(small) 4-8kg
(medium) 8-12kg
no preference

Hair:
Short
Long
No preference

Temperament:
Quiet/docile
Moderately active
Energetic

Have you owned or cared for a dog before?:
Yes
No

Do you own a dog now?:
Yes
No

If yes please specify breed and age of dog:

Do you currently own any other animals?:
Yes
No

If yes please specify::

Are you able to exercise the dog?:
Yes
No

Where will the dog be housed?:
Townhouse
Home Unit
House with yard
House with acres

Has permission been obtained from landlord/owner of property?:
Yes
No

Is the property or part thereof securely fenced?:
Yes
No