Name | Address | Contact Details
Title First Name * Last Name * Address * Street Address Apt, Suite, Bldg. (optional) City State / Province / Region Postal / Zip Code Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo (Brazzaville) Congo Costa Rica Cote d\'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor Timur) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palestinian Territory Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Western Sahara Western Samoa Yemen Zambia Zimbabwe Country
Email * Home Telephone Mobile
Your Military Service Details
Branch of Service (e.g. Army, RN, RAF, MN) Service No. Regiment, Ship etc. Date of Joining Date of Discharge Details of where you served and rank
Decorations
Your Household
How many people live in the household Number of Adults Number of Children Children's Ages Do you have regular visitors to the household Number of Adults Number of Children Please describe below how often they visit and the ages of the children
What type of accommodation do you live in House Flat Bungalow Other Do you Own Rent Other Do you have a garden Yes No Shared Is it fully enclosed Yes No Please describe below the height and type of fence
Are you planning on any of the following
A Baby Yes No Moving House Yes No Change of working hours Yes No Holiday in the next three months Yes No Present Working Hours/Commitments. Are you currently Full-time worker Part-time worker Serving Service Personnel Retired Service Personnel Further education: Currently unemployed Other Do You Shiftwork Night shift Work away from home Work from home Other Have you or anyone in your immediate family ever been convicted of abusing or being cruel to an animal Yes No How many hours on average would your dog be left alone daily Have you considered taking your dog to work with you Yes No Not Possible Do you own another dog/dogs Yes No
If yes please fill in the details below
Breed Gender Age Last Vaccinated Neutered Yes No Do you own any other pets. Please detail below
Have you owned a dog before As a Child As an Adult Never Please provide details
What type of dog are you looking for
Age, breed, gender, characteristics, activity levels, etc……..
Would your new dog come into contact with other dogs on a regular basis Yes No If yes please specify
Would your new dog need to able to adapt well to any of the following
Regular Travelling/Holiday ie caravanning/camping Yes No Being around livestock/poultry Yes No Having a dog sitter/walker Yes No Travel on public transport Yes No Around environments with a lot of people. Yes No Other (please state below)
Please use this box to note down any other information that you feel might relate to your application
e.g. how much exercise, training and socialisation you could provide etc….
TERMS AND CONDITIONS – PLEASE READ AND TICK TO AGREE
You understand that the dog will be rehomed as a house pet and is not to be kenneled or chained up outside. The dog will be rehomed to you as a companion, not as a guard dog or for breeding purposes. BraveHound reserves the right to reclaim the dog if it feels the dog is not being fed, housed or cared for to its satisfaction. Should the dog ever leave your care BraveHound should be contacted and the dog returned to them You are over the age of 18 You understand that although BraveHound will provide you with as much information as they can about the dog, we do not always have a complete history and therefore cannot guarantee behavior etc. You understand that BraveHound is here to advise and support on any aspect of training and caring for the dog. It may take 6 months for the dog to settle in. If you live in rented accommodation, you will undertake to provide proof of the allowance of dogs in your property before any dog can be reserved for adoption. I agree to BraveHound discussing my service history and suitability with PRU I agree to meet and contact BraveHound staff as agreed to in the programme of support and training. I agree when requested by BraveHound to attend Glenbrae Veterinary Practice Additional Information Upload here How did you hear about the BRAVEHOUND Programme
Date : mm/dd/yy
Thank You for your time
