EmailMe Form - Application Form

Name

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Age

Email

Home Phone *

Mobile Number

Name of dog you are applying for

If fostering, enter FOSTER

Sometimes the dog you apply for may not be available at time of your home check. *

Yes

No

Foster Placement

Please advise (Yes or No) if you would you like to proceed with your application.

Contact details of your vet

Your family/other residents
(please include their ages)

Visiting children?
Please state ages and how often they visit:

Any other pets?

Please include:
Type, age and sex
(Spayed / Neutered )

Should you have a cat please note that we have a Long waiting list for cat friendly Bullies.

Work hours.

Please also include how long the dog will be routinely left alone

Planned exercise routine for your dog

What daily routine will you have?

Please tell us about yourself and your reasons for wanting one of these special dogs.

What experience, if any, have you and your family had with Bull Terriers?

Will the dog have access to the whole of your house whilst you are there?

Where will your dog stay while you are out?

Do you have facilities to keep your rescue dog separate to your existing pets?

Preferred Sex

Male

Female

No Preferance

Preferred Age (if any)

Preferred Colour (if any)

Would you take a Bullie x

Yes

No

Possible

Would you take on a dog with special needs? (such as deafness, known medical conditions, not house trained etc)

Yes

No

What (if any) experience have you had of the above?