Adoption Agreement

What is your employment status? Please select Full time employment Part time employment Casual work Currently unemployed

What is your residency status? Please select NZ Citizen Resident Other

Will the dog have regular contact with children under 5 and/or elderly people? Please select Yes - children under 5 Yes - elderly people Both - elderly people and young children No - neither elderly people or young children

Which best describes your household? Please select Active Noisy Quiet Average

What is your living status? Please select Rent Own

If you rent, please provide us with the landlords name & number (by providing this information you are giving CBBR permission to contact your landlord, please inform them of this call so they can speak with us). If renting, written confirmation is require

Are you applying for a specific dog or pre-approval? Please select: Pre-approval A specific dog

Are you comfortable adopting a dog who:

Requires assistance with toliet training Please select: No - must be toilet trained Yes - I can train them Unsure - maybe

Requires some medical treatment (on-going) Please select: No Yes Unsure - maybe

Requires obedience training Please select: No Yes Unsure - maybe

Is a puppy Please select: No Yes Unsure - maybe

Is NOT cat friendly Please select: No - this dog must like cats Yes Unsure - maybe

Has some special needs (i.e. deaf / blind / other) Please select: No Yes Unsure - maybe

Does not like or is fearful of children Please select: No - the dog must get along with children Yes

Is a senior dog (i.e. over 7 - 8 years) Please select: No Yes

Fearful – these dogs may require extra support, those who are timid & wary No Yes - I am confident in dealing with this behaviour as long as they don't nip out of fear

Requiring socialisation with other dogs Please select: No - this dog MUST be well socialised Yes - I am confident in dealing with this behaviour

Is NOT dog friendly? Please select: No - this dog MUST like other dogs Yes - I am confident in dealing with this behaviour Unsure

Requiring human socialisation – these dogs are timid at times, wary & may require more support Please select: No - this dog MUST be well socialised with humans Yes - I am confident in dealing with this behaviour Unsure

Are you a first time dog owner? Please select: No - I have had other dogs before Yes - this will be my first dog

Do you require a dog who is already trained? Please select: No - I have obedience trained before Yes - I need a dog who is trained

Do you have a lot of experience and can handle a difficult dog? Please select: No Yes

What is your ideal dog and why?

Please provide ALL details of current pets (unless stock, then just name type) MUST include name, breed, sex, age, desexed Y/N, current vax Y/N, registered Y/N

Have you had other pets in the past? Please select: No Yes

Have you ever lost a pet to an accident? Please select: No Yes

Is your yard securely fenced? Please select: Yes - very secure It is mostly secure No it is not secure

If you have a pool is it fenced separately? Please select: I don't have a pool Yes, my pool is fenced separately No, my pool isn't fenced separately

Do you agree to provide regular health care by a licensed veterinarian? Please select: Yes No Unsure

Do you agree to keep the dog as an indoor dog? Please select: Yes No Unsure

If you are outside of Christchurch, are you willing to come to Christchurch to meet the dog? Please select: I live in Christchurch Yes I would travel to Christchurch No - I wouldn't travel to Christchurch I'm unsure at this stage

Do you have any charges pending in respect of animal cruelty and/or have you ever been convicted of animal cruelty? Please select: No Yes

Do you have a regular vet? Please select: No Yes

By submitting this application, I agree that all the information I have provided is correct. Providing untruthful answers or failure to comply with the requirements of this application or the signed adoption agreement can result in the forfeiture of the adoption. You agree to allow us to check the references provided. We will require the successful applicant to sign an adoption agreement & allow a full property check before adoption. Ongoing checks may be required. We appreciate you taking the time to complete this application, upon review & approval, we will contact you as soon as possible. Please note that CBBR takes NO responsibility or liability for any damages or injury the dog may cause to property or persons. While every care is taken to ensure the temperament of the dog, they can have issues. Please be aware of this when submitting this form. We reserve the right to refuse any applicant & will not enter into any further correspondence on our decision. We reserve the right to uplift the dog should any issues arise where the requirements of adoption have not been adhered to or we feel the dog is not being looked after properly.