Cooper

Title*

Forename(s)*

Surname*

Telephone*

Mobile*

Email Address*

Address*

Postcode*

Your Age*

Your Occupation*

Are you a member of team safe?
NoYes

If no, would you like to hear more about Team SAFE and other ways you can support Stray Aid?
NoYes

Tell us about yourself…

Have you previously applied to stray aid for a dog or cat?
YesNo

If yes, when and what type of pet?

What type of dog are you looking for? Please provide further info (e.g. breed, age, sex)*

Have you owned a dog before?
YesNo

If yes, please state for how long you owned him / her and give any relevant detail

Are there any dogs or other dogs living at your property or visiting regularly?
YesNo

If yes, please give details

Why do you want a new dog?*

What type of accommodation do you live in?
HouseFlatBungalow

Other (Please Specify)

Are you allowed to keep dogs on your property?
YesNo

If yes, how many?

Do you OWN, RENT or SHARE your property?
OwnRentShare

If it is not your property, do you have written permission from the landlord or homeowner to keep a dog?
YesNo

If accommodation is leased/rented we require written permission from the homeowner, or sight of the section of the lease where authorisation is granted.

Will you be moving shortly?
YesNo

Do you have your own garden/yard?
YesNo

Please upload a photo (max file size 10mb)

Will your new dog be exercised regularly?
YesNo

Does your accommodation open directly onto a busy road?
YesNo

If your garden is not secure, would you be prepared to make it so?
YesNoAlready Secure

Please provide photos of existing outside space (max file size 10mb)*

How many people live in your household?

Adults (State number)

Children (State number)

Ages of Children (Seperate by a comma)

Is a new family member or baby expected in the next 3 months?
YesNo

IF YES, Please provide further information

Are there children who regularly visit your household?
(e.g. grand children, friend?
YesNo

IF YES, how often and what ages?

Is anybody in your household allergic to dogs/an asthma sufferer?
YesNo

If yes, please give details

Please state where the dogs will stay during the night*

Please provide a photo (max file size 10mb)*

Please state where the dogs will stay during the day*

Please provide a photo (max file size 10mb)*

Please provide any further information that may be relevant

Please provide a photo if appropriate (max file size 10mb)

Do you have any holidays planned?
YesNo

If yes, when and for what duration?

Please state where the dog will stay if you go away*

On an average day, how long will your dog be left on its own and why?*

If left on a regular basis, what provision will be made to provide company and toilet breaks for your rescue dog?*

Please indicate how much you think it may cost to:

Vaccinate your dog each year?*

Insure your dog each year?*

Feed your dog each week?*

Please give the name of your veterinary surgeon, if applicable:

Where did you hear about stray aid and our dogs?*

Are you happy for one of our staff members or volunteers to visit your home?
YesNo

If no, give details

Have you ever had to have a dog rehomed?
YesNo

If yes, give details

Have you, or anyone in your household, ever been accused of, or convicted of, an offence of neglect or cruelty against animals?
YesNo

If yes, give details

Are there any other comments you would like to make to support your application?

By signing this form, I state that all information provided is accurate, and agree to be bound by Stray Aid’s Terms and Conditions.

I confirm that I have read the terms and conditions before completing this Registration Form and I accept and agree to be bound by them?
I CAN CONFIRMI CAN NOT CONFIRM

Terms and Conditions

SIGNATURE* (Please state name online)

TYPE FULL NAME*

Date*

Cooper

Cooper

Registration Form

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