Mobile: 0414 566 275
PO Box 599Wallaroo SA 5556(We are not a Shelter, No Public Access)
YP Puppy RescueCharity Licence - CCP 2425
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* = Mandatory Fields
Daytime telephone number
Evening / Night time telephone no
Address where animal will be housed (Please include Postcode & Council)
Postal Address (if different to above)
Who are you adopting the animal for?
If another person, name of person
Applying for a Dog or Cat ?
Which animal are you hoping to adopt?
Please provide some information on why you would like to adopt and why you think this animal will be right for you.
Are you currently employed
Work from home
Type of employment
Exercise, Activities & Characteristics
I'm a jogger - daily runs suit me
I like to walk for fitness - but I'm no athlete
I prefer to stroll to the local shops
I'm looking for a animal that enjoys the comforts of home
How much exercise would you and your dog enjoy together?
What weekend activities would you expect to enjoy with your dog?
What are the characteristics you most look for in a animal?
What are the characteristics you would least like in a animal?
Have you had pets previously in your adult life?
Do you currently have any other pets
If yes, please give details of current pets
If you have animals, are their vaccinations up to date?
A copy of current vaccination certificate may be required.
How do your current pets get along with other animals?
Have you had previous experience in any of these?
If yes to Obedience Classes, please provide the name of the club.
Please provide the names and ages of the regular occupants of the household.
Is anyone in the household allergic to animals
If yes, please provide details
Who will generally be responsible for the care of the animal.
Is everyone in the household in agreement about adopting a animal.
Do you own or rent your home? If renting, a written letter of approval from the Landlord must be provided, within 1 week from the date of this application, or the application will be withdrawn.
What kind of yard and fencing do you have?
Where will your animal be during the day? Inside or Outside and what type of shelter is provided if outside ?
Where will your animal be located at night? Inside or Outside and what type of shelter is provided if outside ?
What type of building do you live in?
If Other, please explain
Are you happy for us to conduct a yard check?
How will your dog be cared for when you go on holiday?
Health, Care and Expenses
Are you aware of, and prepared for the ongoing costs involved with Animal ownership? Expenses can include: yearly vaccinations, food, worming, flea treatments and unexpected Vet bills.
Have you ever had to rehome or give away a previous pet?
If yes, please explain
If relevant, please provide your current Vet's name
Will this be the vet for this animal?
If no, please provide the details of the proposed vet.
Alternate Vet's address
Alternate Vet's Phone Number if applicable.
If you adopted from us, would you be willing to provide occasional updates (emails and/or photos) as to how your pet is adapting to life with you?
Any further comments you would like to include?
Please advise where you heard about YP Puppy Rescue.
Please type what is listed above.
By submitting this questionnaire, you agree that ALL the information you have provided is correct.
You understand that providing untruthful answers or failure to comply with the requirements of this application can result in the refusal of this adoption.
You understand that in some instances a property check will be required.
We reserve the right to refuse any applicant.