Anoux Massey



|Date: Name of animal to be adopted: |

|Cat/dog/other: Age: Sex: Breed: |

|Description/Identifying Marks: |

|Name of staff member/volunteer handling the adoption: |

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|Name of PET applying for | |

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|Your Name and Surname | |

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|ID Number | |

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|Address where pet will live | |

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|Contact Number: Cell (2 Cell Numbers) | |

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|Contact Address: Email (2 Addresses) | |

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|Are there kids residing at the home where the dog will be | |

|living and what are their ages? | |

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|Do you have other DOGS OR CATS? If so, which: | |

|If so: | |

|Quanitity | |

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|Age(s) & Gender(s) | |

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|Sterilised YES OR NO? | |

|If not sterilised please provide a reason | |

|Did any of your animals have a litter before sterilisation? | |

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|Are your pets (cats & dogs) fully vaccinated? | |

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|What diet are your pets on? | |

|Quantity hours dog would be alone for during the day | |

|If someone is at home during the day, who are they and for how | |

|long ? | |

|Reason you want to adopt a dog? | |

|Watchdog/Protection/Breeding?Companion/Gift? | |

|Please specify... | |

|Have you ever surrendered your animal to a rescue organisation | |

|or given a pet away? If so, Why? | |

|What happened with previous companions who are no longer with | |

|you? | |

|Have any of your companions gone missing. If so explain the | |

|circumstances and were they found? | |

|Are you prepared to provide a PERMANENT home for the life of |NOTE DOGS CAN LIVE UP TO 15 YEARS!! |

|this animal? | |

|Are you willing to put up with digging, chewing, potty | |

|training, barking etc until the pup is trained? | |

|Who will be responsible for your pets when you go on holiday? | |

|Have you made provision if something should | |

|happen to you, and who will be responsible for your pets? | |

|What will happen to your pets should your circumstances change?| |

|Ie. Loss of job or moving into a smaller house or a place that | |

|does not allow animals? | |

|Where will the dog sleep at night | |

|(In the house or outside)? | |

|If outside, what shelter will be provided? | |

|If animal will sleep outside, will they be allowed inside and | |

|when? | |

|Do you have a FENCED / GATED yard? | |

|Do you have a pool. If YES, is the pool enclosed? | |

|How often will feeding take place? | |

|What size garden will the animal have access to (Small / Medium| |

|/ Large)? | |

|Will you have time to play, walk and groom your dog? | |

|Have any animal died on your premises due to Parvo / Distemper?| |

|If so, how long ago? | |

|Are you able to provide Vetrinary care, quality dog food, and | |

|grooming for your pet? | |

|Are you planning on moving within the next year? | |

|What will happen to your pets should you move? | |

|Type of housing? | |

|House/Flat/Relatives. | |

|Rent or Own? | |

|Do you have your own transport? | |

|If you rent, do you have permission to own a dog / dogs? | |

|Do you understand that your dog must be vacinated yearly, | |

|dewormed every 6 months at least and be treated for ticks and | |

|fleas every month (at your own cost)? | |

|Do you understand and accept that if you are adopting a young | |

|animal, the animal MUST be sterilised at 6 months of age | |

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|REFERENCE 1 : Name and Relationship to you | |

|Address | |

|Cell and Landline | |

|Email address | |

|REFERENCE 2 : Name and Relationship to you | |

|Address | |

|Cell and Landline | |

PLEASE READ THROUGH CAREFULLY BEFORE TAKING YOUR COMPANION HOME – THIS IS A LEGAL DOCUMENT:

It is hereby certified that in the event of this application being approved, the above mentioned applicant has adopted a companion/s from A NEW HOPE subject to the following conditions:

1. The applicant undertakes to care for, love and make part of the family their new companion. They promise to make sure the animal/s is/are comfortable with suitable shelter and that fresh food and water is provided at least twice per day.

2. The applicant undertakes to keep the new companion properly enclosed (preferably indoors) for a timeframe as long as may be required for the new companion to become accustomed with its new surroundings – the timeframe for such enclosure may vary from a couple of days to a couple of weeks, depending on each companion.

3. The applicant undertakes to provide the pet with positive identification AND a contact telephone number IMMEDIATELY after adopting the new pet – such identification should at least entail a collar and name tag suitably fitted to the pet, all pet’s are microchipped by ANH before going home.

4. The applicant understands that the animal/s MAY NOT be chained or fastened under any circumstances and must be allowed full access to the available property/yard. The animal may not be locked in a small enclosed space alone for any reason.

5. The applicant undertakes to fully vaccinate the adopted animal yearly in the case of an adult and at 8 and 12 weeks for a puppy and yearly thereafter.

6. The applicant undertakes to sterilise the adopted animal at a vet that is on the list of A NEW HOPE at 6 months of age. Should the applicant adopt an un-sterilised older animal due to unforseen circumstances, arrangements will be made to sterilise the animal as soon as possible

7. Should the applicant wish to use their own vet, proof of sterilization needs to emailed through to A NEW HOPE on request.

8. Should the applicant use their own vet for sterilisation A NEW HOPE will not be responsible for payment in full or part.

9. The applicant agrees to random/follow-up checks by A NEW HOPE in order that the sanctuary can confirm that the animal/s is/are receiving suitable housing and care. The applicant understands that A NEW HOPE has the right to remove the animal/s immediately should the applicant fail to comply with the rules and regulations as stipulated in this document.

10. If for any reason, the applicant decides that he/she no longer wants the animal/s, the animal/s will not be placed in a new home without the permission of A NEW HOPE or returned to A NEW HOPE for rehoming.

11. Should there be any behavioral and/or adjustment issues applicant must contact A NEW HOPE immediately to assist. Under no circumstances may any animal be privately rehomed – the animal must be returned to A NEW HOPE.

12. If you cannot keep your adopted dog you will need to return him/her to A NEW HOPE

13. Under no circumstances may an animal be euthanised for NON MEDICAL RELATED REASONS – the animal should be returned to A NEW HOPE

14. All microchips will remain registered to A NEW HOPE, should your pet go missing please contact us immediately.

15. A NEW HOPE will cover vet costs at their approved vets only for 1 WEEK (7 days) after adoption – applicants must contact A NEW HOPE to arrange a vet visit should their dog appear to be unwell in anyway in the first week after adoption. Should the applicants use their own vets they will be responsible for payment.

16. A NEW HOPE will not be held responsible for any vet costs after 7 days once the dog has been adopted unless agreed before adoption.

17. Adoption fees paid are non-refundable should the dog be returned at any time.

18. Adoption fees must be paid in full before your adopted dog goes home.

Signed on the………......day of ..............(year)........at..................................................................

Applicant’s signature:…………......................................................………………………Full name &

Staff member/volunteer’s signature:………………………………………..Full Name:…………….......................................…

STERILISATION CONTRACT –

only applicable for adoptions of animals under 6 months of age

Name: .......................................................................................................................................................................................................................................................

Address:.....................................................................................................................................................................................................................................................

Telephone numbers (h): ...........................................................................................(c)............................................................................................................................

Animal’s name:....................................................................................................................Sex:......................................................Age:.................................................

Description:......................................................................................................................................

On the understanding that you will arrange to have this done at a A NEW HOPE vet or if you would like to do it through your own vet, that you will fax us the proof thereof.

1. Should the animal be taken to another vet for this surgical procedure without the written authorisation of this society, the owner will be responsible for the payment of any fees incurred.

2. If the animal is not sterilised onthe at 6 months of age, the society reserves the right to confiscate the animal and NO MONEY WILL BE REFUNDED. The owner agrees that a member of the A NEW HOPE staff may enter upon their premises in order to remove and/or inspect the animal.

3. In the event of the animal’s death, proof must be submitted to the society within seven (7) days.

I have read and fully understand the conditions above, which I accept unconditionally.

Signature of new owner:............................................................................................

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A New Hope Dog Rescue

NPC 2017/083180/08

Tel – 081 893 4427

Email – stirling.liv@

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