Home Enquiry Form

Name:*

Your Email:*

Occupation:*

Full address including postcode:*

Landline Number:

Mobile:

I am interested in adopting a:*
Bedlington TerrierCross

How many hours a day will the dog be left alone?:*

Relationship Status?:*
SingleIn a relationshipMarriedDivorcedWidowed

If you have a partner, what is their profession?:

Please indicate the age range(s) applicable to you and your partner:*
18-2526-4546-6061-7071-75Over 75

Do you currently have a dog(s) at home?:*
Please choose:YesNo

If YES, how many? Please also give details on breed / sex / age / are they neutered?:

If you don't currently have a dog, have you or your partner ever owned one?:*
Please choose:YesNo

If YES, how many? Please also give details on breed / sex

Do you ever look after or have dogs visiting?:*
Please choose:YesNo

If YES, please give full details on age / breed / sex / neutered:

Do you have children at home?:*
Please choose:YesNo

If YES, how many and what ages?:

Do you have children visiting regularly?:*
Please choose:YesNo

If YES, how many and what ages?:

Do you have any other small pets (including cats) or livestock?:*
Please choose:YesNo

If YES, please give details:

How many years have you lived at your current address:*

What is your home like? House / Flat / Farm / Bungalow / Private or Shared Garden / Other (Please specify):

If you have a garden, is it adequately fenced?:*
Please choose:YesNo

If YES, approximate height:

Do you live in the:*
Please choose:CountryTownCity

How many adults live in the home?:*

Do you rent or own your home?:*

If your rent your home, what are the details of your tenancy agreement regarding pets?:

What would you say is the average activity level of your household?:*
Please choose:QuietAverageBusy

Does anyone in the household suffer from allergies relating to dogs?:*
Please choose:YesNo

If YES, please give details:

Is EVERYONE in the household happy with the decision to adopt a rescue dog?:*
Please choose:YesNo

Are you aware that Bedlington Terriers have a high maintenance coat and most need trimming / grooming every 6-8 weeks?:*
Please choose:YesNo

What age dog are you looking to adopt? Please state minimum and maximum age and if you would consider a puppy:*

Do you have a preference on adopting a dog or a bitch?:*
Please choose:DogBitchNo preference

What are your reasons for wanting to adopt a Bedlington Terrier?:*

Have you had any past experience with Bedlington Terriers?:*
Please choose:YesNo

If YES, please give details:

Would you consider taking on two dogs that have grown up together?:*
Please choose:YesNo

Can you consider taking on a dog with special needs eg. deaf / blind / on medication etc?:*
Please choose:YesNo

Have you ever surrendered a dog before?:*
Please choose:YesNo

If YES, please give full details:

Have you got any personal experience with formally training dogs?:*
Please choose:YesNo

If YES, please give details of the training methods you use - reward based or otherwise:

Do you have a local veterinary practice?:*
Please choose:YesNo

Have you used this practice in the past?:*
Please choose:YesNo

Do you agree to provide regular health care?:*
Please choose:YesNo

Do you agree to give the dog a safe and loving home?:*
Please choose:YesNo

Do you agree to allow a BTR representative to do a home visit?:*
Please choose:YesNo

Do you agree to return to BTR our rescue dog you can no longer keep it for whatever reason?:*
Please choose:YesNo

Would you be happy for BTR to obtain a character reference if required?:*
Please choose:YesNo

Have you ever applied to any other Rescue Organisation for a dog?:*
Please choose:YesNo

If YES, which one(s)?:
Please choose:YesNo

Would you consider professional dog training for the dog if needed or requested by BTR?:*
Please choose:YesNo

If NO, what are your reasons?

Would you be prepared to take on a dog with behavioural issues and work with us and a BTR appointed behaviourist?:*
Please choose:YesNo

If NO, please tell us why?:

If we are unable to offer you a dog within 6 months, would you still like us to keep you on our adoption list?:*
Please choose:YesNo

If you have anything else to add that you think that we should know, or any particular specifications, please state them here: