Self-Disclosure Form for Adopters Adopter Self-Disclosure Form What is the name of the animal you would like to adopt? Personal Information Salutation MsMrDiverse First Name Last Name Date of Birth (DD.MM.YYYY) Street House Number Postal Code City Country Mobile Number Email Address Do you have a Facebook/Instagram profile? YesNo Please insert the link Occupation Employment Status Have you already been in contact with someone from LokkusDogsandCatscare? YesNo If yes, with whom? Do you have previous experience with dogs? I have had dogs beforeI currently have other dogsI have never had a dog Do you have experience with rescue or shelter dogs? YesNo Do other people live in your household? Yes, partnerYes, childrenYes, othersNo, I live alone Do you already have pets? Yes, dog(s)Yes, cat(s)Yes, otherNo Living Situation What type of housing do you live in? OwnedRentedHouseGardenBalconyYard On which floor do you live? Is there an elevator? How many square meters is your living space? What is your surrounding area like? How far is the nearest green area? How long will your dog be alone each day? Where will the dog live in your home? Which rooms will be accessible to them? Additional Questions Have you also applied to another organization for a dog? YesNo What do you wish for in your dog? What should their character be like? Why did you decide to adopt a rescue dog? In some federal states specific regulations apply. Do you have a dog handling license or certificate of competence if required? YesNo In case of illness, vacation or unforeseen circumstances, could you arrange alternative care for your dog? YesNo Do you agree to stay in contact with the organization’s adoption representative and allow a (virtual) follow-up visit within a certain period? YesNo From when could the dog move in with you? Are you also interested in adopting another furry friend? If yes, what kind would you prefer? Do you have any further questions or comments? Have you answered all questions truthfully? Yes, I have answered all questions truthfully and I am aware that false statements may lead to the termination of the adoption agreement. I have read and agree to the privacy policy. I consent to my data being stored permanently for contact and follow-up purposes. Note: You can revoke your consent at any time by emailing info@tierheim-sri-lanka.de.
