ANGELS SMALL PAWS HOMECHECK REQUEST
DO NOT FILL OUT THIS FORM FOR ENQUIRIES - IT IS FOR HOMECHECK REQUESTS ONLY
FOR ENQUIRIES EMAIL - homecheckme@gmail.com

Homecheck information PLEASE FILL IN ALL FIELDS ON THIS FORM. Our minimum adoption donation is £300 (the donation is higher for pups and ex-breeders) to be paid in full at adoption and is NOT REFUNDABLE, this includes neutering, vaccinations, flea, worming and chipped, plus 4weeks free pet insurance and lifetime back up from the rescue.
If you are successful in passing your homecheck we ask that you keep looking at the dogs on our Facebook page or website, and when you see a dog you're interested in and fits your adoption criteria, comment on the dog's picture to be added to their file. When the dog is ready for adoption the main admin will look through the forms of those interested. The person/family who best meets the needs of the dog will be invited to meet the dog in their foster home. The family along with any resident children and dogs will need to come along and meet the rescue dog, if the meet goes well you will be able to adopt the dog after paying the adoption donation. You will need to travel to meet any of our dogs, with resident dogs and children, we are based in the East Midlands.
IMPORTANT INFORMATION
FIRST NAME *
SURNAME *
WHAT IS YOUR DATE OF BIRTH? (dd/mm/yyyy) *
PLEASE STATE WHICH DOG YOU ARE INTERESTED IN ADOPTING? *
ARE YOU ON FACEBOOK, IF SO WHAT IS YOUR FACEBOOK NAME? *
1ST LINE OF ADDRESS INCLUDE HOUSE NUMBER & STREET NAME *
TOWN OR CITY *
POSTCODE *
PHONE NUMBER, INCLUDE MOBILE *
YOUR FULL POSTCODE IS USED ON A CLOSED FACEBOOK GROUP, TO ALLOW US TO FIND A HOMECHECKER WHO IS THE CLOSEST MOST SUITABLE MATCH FOR YOUR HOMECHECK. ONCE YOUR HOMECHECK IS COVERED THE POST IS DELETED FROM THE GROUP. PLEASE TICK TO AGREE OR DISAGREE (PLEASE NOTE IF YOU DO NOT AGREE WE ARE UNABLE TO CARRY OUT YOUR HOMECHECK) *
EMAIL ADDRESS *
OUR DOGS ARE FOSTERED IN DERBY & SURROUNDING AREAS, ARE YOU ABLE TO TRAVEL WITH ANY RESIDENT DOGS OR CHILDREN TO MEET A DOG? (IF NOT WE ARE UNABLE TO GO AHEAD WITH A HOMECHECK) *
TYPE OF ACCOMMODATION *
HOME RENTED OR OWNED - IF RENTED WE NEED PROOF FROM LANDLORD THAT YOU CAN KEEP A DOG & HOW MANY? IF WE DON'T RECEIVE THIS A HOMECHECK CANNOT BE ARRANGED. **PLEASE SEND A SCAN OR PHOTO OF THIS PART OF YOUR RENT AGREEMENT TO homecheckme@gmail.com *
DO YOU HAVE A SECURE GARDEN? *
WHAT IS THE HEIGHT OF YOUR FENCE/HEDGE? *
DO YOU WORK? *
STATE START & END TIME OF WORKING DAY & HOW MANY DAYS A WEEK, INCLUDE TRAVEL TIMES, FOR ALL RESIDENT ADULTS? *
IF YOU WORK FROM HOME IS THIS *
HOW MANY HOURS WOULD A DOG BE LEFT? (If out at work or for shopping etc.) *
DO YOU HAVE ANY RESIDENT OR VISITING CHILDREN? *
HOW MANY CHILDREN & THEIR AGES? *
DO YOU HAVE ANY DOGS? *
IF YOU HAVE A DOG WHAT BREED, AGE & SEX ARE THEY? *
IF YOU HAVE A DOG/S ARE THEY SPAYED/NEUTERED? WE MAY ASK YOU TO PROVIDE VETERINARY PROOF FOR SPAY *
DO YOU HAVE ANY OTHER PETS IF SO PLEASE STATE TYPE OF ANIMAL? *
HAVE YOU APPLIED TO ANY OTHER RESCUE, IF SO PLEASE STATE WHICH RESCUE & WHEN *
HAVE YOU OR ANY FAMILY MEMBER HAD ANY SYMPTOMS OR BEEN DIAGNOSED WITH CORONAVIRUS OVER THE LAST 2 WEEKS? (high temperature, continuous cough or loss/change in sense of taste) *
HAVE YOU, OR ANY FAMILY MEMBER BEEN ASKED TO ISOLATE BECAUSE YOU/THEY HAVE BEEN IN CONTACT WITH SOMEONE DIAGNOSED WITH CORONAVIRUS, OVER THE LAST 2 WEEKS? *
IMPORTANT NOTICE: If you fail to inform us of something that later on proves to be detrimental to the placement of one of our dogs, that leads to the dog being placed within an unsuitable environment, which could be a danger to the dog and or your family, or if an incident occurred where either you, a member of your family or a third party were injured, then  Angels Small Paws Dog Rescue and Animal Sanctuary  will not be held accountable and the Rescue  may decide to take legal proceedings against you.    PLEASE NOTE: Angels Small Paws Dog Rescue and Animal Sanctuary RESERVE THE RIGHT, IN OUR SOLE DISCRETION, TO REFUSE ANY APPLICATION WE DEEM UNSUITABLE FOR A RESCUE DOG THAT WE BELIEVE TO BE INAPPROPRIATE TO THE NEEDS OF A RESCUE DOG. By submitting this form you understand and agree to the above. *
I/We confirm that all of the information disclosed on this document is a true and accurate account.  I/We have not withheld any information which is relevant to the safe re-homing of a dog.   I/We confirm that we give Angels Small Paws Dog Rescue and Animal Sanctuary permission to hold our details on file securely, subject to data protection laws. I/We also give permission for the Rescue to arrange for a homecheck to be performed to ensure our suitability to adopt a dog. BY AGREEING AND SENDING THIS FORM YOU UNDERSTAND AND AGREE TO THE ABOVE. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy