Fillable MDH Adoption Form 2021v3

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MDH Adoption Form 2021v3

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ADOPTION
APPLICATION
FORM
Manchester & Cheshire Dogs’ Home
PLEASE NOTE:
• This application form is for Manchester Dogs’ Home, please contact Cheshire Dogs’ Home directly on 0300 102 1212 if you wish to adopt
from there.
• Please be aware that our Adoption procedure has changed.
• Please read the following to ensure you are able to adhere to the procedure we currently have in place.
• You must be over the age of 18 to make an application to adopt.
Adoption Requirements
• This is a multi-stage application; the stages are as follows:
▪ Completed application received.
▪ Application assessed by one of the adoptions team.
▪ If we feel we have a dog who would suit your needs and visa versa, a member of the team will contact you to arrange
a virtual home visit.
▪ Virtual home visit undertaken by the adoptions team.
▪ If successful you will be given an appointment to come in and meet the dog.
▪ Depending on the dogs needs – this could take several visits.
• We may need to contact you to clarify information on the application form, please ensure there is at least one valid phone number on
the form.
• We need the following information sending through to us BEFORE your virtual home visit and to proceed with the application:
▪ Identification – 1 x Utility Bill (something with your address on it), 1 x Photo ID (Driving Licence)
▪ If you rent, written permission from your landlord you can have a dog. A copy of your tenancy agreement will not be
suitable unless it clearly states pets can be kept.
▪ If you own, a mortgage statement, or proof of building insurance.
▪ This information is required via E-mail. Please email to reception@dogshome.net
If you do not have email, please mail copies to the above to Manchester Dogs’ Home, Crofters House, Moss Brook
Road, M9 5PG.
TERMS AND CONDITIONS OF ADOPTION
Please read and ensure you fully understand these terms and conditions as they form the basis of the legal adoption between Manchester &
Cheshire Dogs Home and yourselves. (The Owner/Keeper)
• I understand that this dog is a stray or unwanted dog and I accept the dog with all its faults be that behaviour, physical or mental.
• I understand this dog is likely to have Kennel Cough and could be harbouring other diseases and
I do not hold Manchester & Cheshire Dogs Home responsible for the costs in treating such conditions.
• I understand that this dog may have behavioural problems or traits that the Home will not have seen in the Kennel Environment.
• I understand that from the point of signing onwards I am responsible for the dog and any veterinary treatment it incurs.
• I understand that from the point of signing onwards I am the responsible keeper and owner of the dog and the microchip will be
registered in my name and address.
• I accept that from the point of signing, if the dog is found to be aggressive, out of control in a public place or if the dog bites someone I
am responsible for all fines, charges and penalties and I will not seek to have these reimbursed by Manchester & Cheshire Dogs Home.
• I am a private individual and I am adopting the dog as a family pet
• I am not looking to profit from the dog by working the dog.
• I will not breed from the dog.
• I do not work for and will not pass the dog onto another rescue centre.
• If the dog is found to be unsuitable I will, in the first instance contact Manchester & Cheshire Dogs Home to assess the suitability for
rehoming the dog with them.
• I am over 18 Years Old
• I have advised the Manchester & Cheshire Dogs Home of all of the people and pets living in my house and we have undertaken the
required assessments. I will not hold the Home responsible for loss or injury as a result of any third party interaction with the dog.
• I understand and abide by these terms and conditions.
• I understand that by signing below I am agreeing to be bound by these terms and conditions.
By Initialling and dating below, I confirm that I have read the above, I am happy to proceed with the application process, I can supply the written
permission required and I will ensure information is received prior to the Home making any appointments. I agree to be bound by the terms and
conditions of adoption.
DATE: ______/______/______ INITALS: ________________
Manchester & Cheshire Dogs’ Home
Adoption Questionnaire
Dog Name
Reference No.
What made you choose this dog?
Have you owned a dog before?
YES NO
If yes, please provide details of breed, temperament, and any behavioural difficulties you may have worked with
during this time.
Do you have experience of rescue dogs or those that have lived in a previous home?
YES NO
Please tell us everyone who lives in your house (or visits regularly) Please include ages of children.
Does anyone who lives in your house (or visits regularly) have any allergies? YES NO
If yes, please give details
Manchester & Cheshire Dogs’ Home
Do you have any other pets or animals YES NO
If yes, please give details
Do you have any other pets/animals visit regularly? YES NO
If yes, please give details, include details of if they are neutered/vaccinated or under vet treatment.
Is your property - Owned Rented
Type of property - Flat Detached House
Semi Detached House Terraced House
Bungalow Other: _______________________________
Do you have a secure garden/yard? YES NO
Roughly how high are the walls/fences?
How much exercise would you be able to provide the dog each day?
Do you have experience of dogs that require training and socialisation? YES NO
If yes, please give details
Manchester & Cheshire Dogs’ Home
is this something you are able to provide for a new addition? YES NO
How much exercise would you be able to provide the dog each day?
What work commitments do you have?
How many hours a day and how often would the dog be left alone?
If you are out of the house for long periods of time, what steps do you have in place for when the dog is left?
Do you have someone who can care for the dog in cases of emergency? Yes No
If yes, please give details:
Are there any planned changes to your circumstances in the near future that we should know about? YES NO
If yes, please give details:
(I.e., New baby, change of working hours, moving to a new house, etc.)
Are you currently registered with a vet? YES NO
We may contact your vet for a reference? YES NO
Vet Name, Address and Telephone No.
Any other information you think we should know?
Manchester & Cheshire Dogs’ Home
Your Details
Name:
Address:
Landline No.:
Mobile No.:
Email Address:
I hereby confirm that the information provided above is accurate, correct, and complete.
I am aware that missing or incomplete information could affect my application.
I understand my details will be held on record with Manchester Dogs’ Home as a potential or successful adopter in line
with our Privacy Policy (a copy of which can be found on our website)
Signed:
Date
We are required to keep details of financial transactions for up to 10 years, as such your details may be held on our database for that time. You
have the right to be removed from the database after that time by informing us in writing to the Manchester Dogs Home address above.
During this time, we may contact you about special offers, promotions, fundraising etc.
I am happy to be contacted.
I do not want to be contacted.
Internal Office Use Only
Application Successful YES NO
Date of Virtual Home
Visit
Logged on Anilog YES NO
Application Uploaded YES NO
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MDH Adoption Form 2021v3

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Completed 30 October 2021

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