Diann v Heerden C: 083 4199110 F: 0866219546
Michelle Zerbe C: 071365 3273
Michelle Lenard C: 082410 1822
Tania Opperman C: 084 830 1931
ADOPTION APPLICATION
Please complete and return electronically or email to OR or fax to 0866219546 or hand in personally or any of the above mentioned email addresses.
PLEASE NOTE: We are cautious about rehoming Pekes in homes with large breed dogs.
Every situation will based on merit
- PERSONAL DETAILS of applicant.
Full names of applicant: ………………………………………………………………………………
ID Number: …………………………………………………………………………………….. ……. Occupation: ………………………………………….. Employer: ………………………………….
Physical Home Address: ……………………………………………………………………………... ………………………………………………………………………………………………………….
Postal Address: ………………………………………………………………………………………..
Cell No: …………………………………… ………………………………. …………. ……….
Home No: …………………………………Work No: ………………………………………….
E-mail: ………………………………………………………………………………………………
PEKE EXPERIENCE
2.1 Have you ever owned a Peke before?Yes No
If NO – why are you interested in owning one now?
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2.2 Do you know that Peke snore and shed hair 365 days a year and want to be with you all the time? Yes No. Comments? ……………………………………………………….…………………………………………………………………………………………………………………………………………….
2.3.If you have owned a Peke previously or you currently own a Peke, please supply further information. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
3. OTHER ANIMALS IN THE HOUSEHOLD
3.1 What other breed of animals do you own and what are their ages and sex? ……………………………………………………………………………………………………………………………………………………………………………………………………………………
3.2Are they sterilized and up-to-date with their annual vaccinations? …………………………………………………………………………………………………………………………………………………………………………………………………………………
3.3 How do you care for these animals? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
3.4 What happens to these animals when you are at work or go away on vacation? ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
3.5Have you ever surrendered any of your animals to the SPCA or any other animal welfare centre and for what reason? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………
4. ADOPTION PREFERENCES
4.1 What age group would you consider adopting? ……………………………………………….
4.2 Are you interested in a male or female? Why? …………………………………………………………………………………………………………………………………………………………………………………………………………………...
4.3 Would you consider adopting a pair? Yes/No.
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4.4 Colour preference? Fawn/Black/Brindle/Anything
4.5 Would you consider another breed of dog or a peke-cross? Yes/No/Maybe.
5. CONTRACT RQUIREMENTS.
Are you prepared to sign the Peke Haven SA Contract which asks you to:
5.1Keep the Peke healthy and take him/her to the vet when necessary? Yes No
5.2Return the Peke to Peke Haven SA should you no longer be able to keep the Peke for any reason? Yes No
5.3 Make a donation to Peke Haven SA to cover any costs involved in the rescue, rehabilitation & re-homing of the Peke? (approx R900.00 which covers sterilization, inoculation, dentals, de-worming, ears flushed, nails clipped, folds cleaned, micro-chipping & dipped) Yes No
5.4 Add an addendum to your will which gives instruction regarding the returning of the Peke on your death to Peke Haven SA? Yes No
6. HOMELIFE OF YOUR PEKE
6.1 Where will the Peke sleep at night? ......
6.2 Where will the Peke stay when you are at work, on holiday, and/or away over weekends?
…………………………………………………………………………………………………………..…………………………………………………………………………………………………………...
6.3 Can the Peke be secured away from moving vehicles on your property? ......
6.4 Will the Peke be part of your family or left outside? Explain.
......
6.5 What will you feed the Peke? ......
6.6 Where will the Peke be kept during the day? ......
6.7 Is your property securely fenced to keep the Peke secure? Yes No . Explain......
6.8 Have you ever had parvo on your property and stipulate date? Yes No . Explain......
7. RESIDENTS
7.1Do you and your partner both work full day? YesNo. Details? ………………………………………………………………………………………………………………………………………………………………………………………………………………
7.2 Do you have young children? YesNo. If so what are their ages & gender? ……………………………………………………………………………………………………………………………………………………………………………………………………………..
7.3Give details of any other persons living on your property or staying at home. ………………………………………………………………………………………………………………………………………………………………………………………………………………………………
7.4 Details of domestic workers and/or gardeners and/or garden services that come & go during the week? ………………………………………………………………………………………………………………………………………………………………………………………………………………………………
8. RESIDENCE.
8.1 Do you plan on emigrating? Yes No . Details?
………………………………………………………………………………………………………………………………………………………………………………………………………………………………
8.2 Do you own your home or rent?……………………………………………………………………….
8.3 If you rent do you have permission from the landlord to own pets? Yes No .
8.4 Do you have a swimming pool or pond? Yes No .
8.5 Is the pool/pond coveredor fenced securely to prevent access? Yes No . Details?
……………………………………………………………………………………………………………………………………………………………………………………………………………………
8.6 If the pool is not covered can the Peke be secured away from the pool? Yes No . Details? ……………………………………………………………………………………………………….
8.7 Are you prepared to have your home inspected? Yes No
…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
8.8 If ‘yes’, best day & time to conduct a home inspection? ……………………………………………….
8.9 Name and contact details of your current vet? ……………………………………………………………………………………………………………………
8.10 Do we have your permission to contact your vet for a reference? Yes No
9REFERENCES. Name and contact details of two references we may contact:
9.1Full Name: …………………………………………………………………………………………………
Relationship:………………………………………………………………………………………………..
Cell : ………….……………………………… Home/Work tel: ………………………………………
9.2Full Name: …………………………………………………………………………………………………
Relationship:……………………………………………………………………………………………….
Cell: ………….……………………………… Home/Work tel: ………………………………………
10. ADDITIONAL INFORMATION you believe we need to know to support your adoption application?
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
If I am approved to adopt a Rescue Peke I undertake to care for the Peke, to treat him/her as a family member for the rest of his/her life (Pekes can live to 14 years of age). If my circumstances change and I am unable to care for the Peke in any way I will return the Peke to Peke Haven SA. I will sign & abide to all aspects of the Adoption Contract.
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SIGNATURE 1 DATE
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SIGNATURE 2 DATE
PEKE HAVEN SOUTH AFRICANPC (2015/397299/08)