Dog Adoption Application Form (Page 2 of 2) in pdf

Are you willing to attend training classes of any sort with the dog? _________________________________________

Do you have any holidays booked in the next six months? ________________________________________________

If adopting a puppy are you willing to keep the dog in and around the house and garden until they are fully

vaccinated? _________________________________________

CHANTRY VETS SURGERY

Please note : Should your pet need to return for vaccine/neutering , please specify which

location you choose to use: ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Your Signature: ……………………………………………………………………………

PLEASE NOTE: ‘There is a non-refundable deposit of £20.00 required to reserve any dog’

Where did you hear about us?

Already aware of centre/branch

Website

Referred by other establishment

Just passing

Word of mouth

NCC/RSPCA enquiries

Other (please state where)

All personal information supplied by you on this application form will be processed by the RSPCA Leeds, Wakefield & District

Branch (charity number 232223) whose privacy policy is available on request.

We will not pass on your details to third parties but we may contact you with regards to fundraising or events organised by the

RSPCA Leeds, Wakefield & District Branch. If you wish to opt out, please tick the box

FOR OFFICE USE ONLY

Interviewed By:

Date:

Comments:

Date passed for Home Visit:

Date Home Visit passed:

Ledger No:

Name:

Colour:

Type:

Sex:

Age:

Date Last wormed:

Date last Flea treatment:

Date spay/castration was done:

Date spay/castration to do:

Date of first vaccine:

Date of second vaccine:

Rspcaleedswakefield/Applicationformdogsleeds/wakefield/emc/rev1/may16

Dog Adoption Application Form Page 2