Online Application

Please read our Adoption Conditions and fill in the form below to register your interest

Please read our adoption conditions for small animals

I don't have a specific pet in mind

Name of Pet

What made you choose this pet? (required)

What Sort of pet do you Want?

Your Details

Your Name (required)

Date (required)

Your Email (required)

Your Address (required)

Postcode (required)

Contact Number

Your Mobile (required)

Your Environment

Does your home have a fully enclosed garden or yard??
YesNo

Will the pet come into contact with children?
YesNo

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?
YesNo

If very young, what provisions have you made for regular feeds?

Do you Live in a House or Flat?
HouseFlat

If you live in a flat, which floor?

Is your home rented?
YesNo

If yes, can you provide proof you are allowed pets?

Animal Ownership

Have you owned a small animal before?
YesNo

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?
YesNo

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?
YesNo

Does anyone in the household have any allergies?
YesNo

Is the animal going to be kept indoors or outside?
IndoorOutside

Do you have a home set up ready for your pet?
YesNo

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:

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Online Application