Your Environment
Does your home have a fully enclosed garden or yard??Yes No
Will the pet come into contact with children?Yes No
What ages are the children?
Do the children live with you are or just visit?
If visiting children how often will they visit?
Do you Work?Yes No
If very young, what provisions have you made for regular feeds?
Do you Live in a House or Flat?House Flat
If you live in a flat, which floor?
Is your home rented?Yes No
If yes, can you provide proof you are allowed pets?
Animal Ownership
Have you owned a small animal before?Yes No
If yes, was this pet from Bleakholt?
If you have previously owned a small animal before, how long ago?
What happened to your last pet?
Do you have any other animals?Yes No
If so what are they?
Are your pet’s vaccinations up to date?
Are they neutered?
Are you fully aware of the costs of feeding and veterinary treatment?Yes No
Does anyone in the household have any allergies?Yes No
Is the animal going to be kept indoors or outside?Indoor Outside
Do you have a home set up ready for your pet?Yes No
What provisions do you have for the if you are away from home? (holidays/illness etc)
What provision do you have for the winter?
Bleakholt Animal Sanctuary will keep your data for as long as is reasonably necessary to fulfil the purpose for which it was collected. We never sell on any information but we have a legitimate interest in sharing your personal data with the following third parties: the relevant microchipping companies, Petplan and where needed the relevant vets. More information and our privacy policy can be found at www.bleakholt.org
I can confirm the information I have provided is correct to the best of my knowledge. I give my consent for Bleakholt to contact me with news and information about the sanctuary. I understand how my data will be used and consent to Bleakholt storing it for as long as is reasonably necessary.
I am over 18 years of age (required)
Signed (insert name to agree)
Earliest adoption date if successful:
