Name
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First Name
Last Name
Date of Birth
Nationality
Phone Number/ Whatsapp
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
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Employer
How long at current job
Provide two references that are not members of your immediate family
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Do you live in a(n)
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Your home is
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If renting, do you have your landlord's permission to have a dog?
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Who shares your household? (eg. wife/husband, roommate(s) etc)
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Are there children in the home?
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If yes, how many and how old?
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At what age do you feel children are responsible enough to take care of a pet without assistance? (i.e. walk, feed, train)
If your present relationship/ living situation were to change and you were no longer able to care for the dog, a new application must be submitted and approved in order to transfer ownership.
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Does anyone in your household have an allergy to dogs that you are aware of?
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Is someone home during the day? If so, who?
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How many hours will your dog be alone each day?
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Where will your dog spend most of his/her day when you are home? eg. indoors, garage, yard etc.
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Where will the dog stay when he/she is home alone?
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Where will the dog sleep at night? (eg. indoors, outdoors please give details)
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What rooms are off limits in your home?
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What outside areas are available to the dog?
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If you have a yard, is it shared with neighbors?
If yes, is it fenced and what is the type of fence?
Is the fence in good condition with no holes or loose points?
If your dog will have free access to a fenced yard, where is it located?
Who has access to your yard? (check all that apply)
If yes, where is the dog kept while they are working?
Do you trust your workers not to let the dog get out?
How would you describe your dog owning experience?
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If you had a dog before what happened to your dog?
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Do you currently have pets? If yes, please tell us the type, breed, gender, age, neutered)
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How do you feel your current pets will adjust to a new dog in the house?
Have you had experience with behavioral or medical issues with your previous or current pets? If yes, please describe
Why do you want to adopt a rescued dog?
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Share your reasons for wanting a dog? (check all that apply)
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How will you exercise your dog and how often?
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Have you or would you be willing to enroll your current dog(s) in obedience classes? (If needed)
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How would you discipline your dog if he or she misbehaved/ chewed household items?
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What method do you intend to use to housetrain your dog? (check all that apply)
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In which of the following situations might you allow your dog off leash?
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If your dog got out/ was lost, what would you do?
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What food will you feed the dog? (Dry, canned etc. Specify brand if known)
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Would you like food recommendations?
Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new dog? Please state any concerns.
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Are you able to make a long-term commitment to care for your pet for its entire life span?
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Who is your veterinarian (name and phone)
If you do not currently have a vet, would you like a referral?
If you move outside Bali/ outside Indonesia will you bring the dog with you?
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What reasons might force you to give up your dog?
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Is there anything else you would like to share with us?
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Please read and agree to each statement below:
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