RNZFB - Adoption Application Form

Full Name (Required)

Address (Required)

Home phone

Work phone

Mobile

e-mail (Required)

Family Details (Required) (e.g. number and age of children)

Home Information

Is your section fully fenced? (Required)

Yes

If yes, please state materials and height

Do you guarantee the dog will live and sleep inside as a member of the family? (Required)

Yes

Will the dog be left alone inside or outside?

Yes

If yes, for how long and how often?

Work Details (Required) Do the adults in your family work full-time/part-time/away from home? Please give details.

What type of area do you live in?

Suburban

Rural

City

Is anyone disabled or elderly in your home?

Yes

If yes, please advise details.

Hobbies and Pets

What are you or your family's hobbies that would include the dog?

Have you owned a dog previously?

Yes

If Yes what Breed If yes, what breed(s) of dog(s)?

What is your experience with dogs?

Do you currently have a dog?

Yes

If Yes, please advise; Breed, Age, Sex

What pets do you own at the moment?

Adoption Preference

Age Preference

Please indicate which of the following age ranges will be suitable for you:

Under 12 months

12-18 months

9-12 years

Behavioural or Medical Conditions

Please indicate below which of the following behavioural or medical conditions you would consider when adopting a dog:

Over awareness of noise or objects

Over distraction with other dogs or animals

Anxiety

Heightened excitability

Hip or elbow dysplasia

Arthritis (elderly/retired dog)

Eye problems

Skin problems

Would you consider a dog requiring ongoing medical treatment?

Yes

Breed Preference

Please indicate which of the following breeds you would like us to contact you about:(tick boxes below)

German Shepherds

Labradors

Standard Poodles

Golden Retrievers

Labrador Cross Golden Retrievers

Labrador Cross Curly Coated Retrievers

Sex Preference

Please indicate which sex of dog you would consider (all dogs are desexed):

Male

Female

Declaration

I understand that Guide Dog Services will keep my application active for two years. If I wish to continue to be considered for a career changed/retired dog after that time I will contact Guide Dog Services to reapply.

The Royal New Zealand Foundation of the Blind

Adoption Application Form

Open to New Zealand residents only.