Adoption Form

Name of the dog you are interested to adopt *

Your Name *

D.O.B (DD/MM/YYYY) *

Occupation *

Address (Where dog will be kept) *

Handphone No. *

E-mail *

Reason for wanting to adopt a dog *

Others: Please provide more details below

Do you drive? *YesNo

Do you possess a transport of yr own? *YesNo

Type of housing *

Others: Please provide more details below

Home ownership *

How many adults in the household? *

Age range of adults in the household? *

Do the adults have any allergies? *YesNo

Age range of children in the household? *

Do the children have any allergies? *YesNo

How many children in the household? *

Who will be responsible for:

Feeding the dog? *

Walking the dog? *

Bathing the dog? *

Bringing the dog to the vet? *

Looking after the dog? *

Where do you intend to keep your dog? *IndoorOutdoorBoth

Have you had other pets before? *YesNo

If yes, what kind? *

Duration owned: *

Do you still own a pet? *YesNo

If no, what happened? *

Do you have a regular veterinarian? *YesNo

If yes, please provide clinic name:

Have you ever given up any dog to a shelter? *YesNo

If yes, why?

Who will take care of your dog when you are out of town for business or vacation trips? *

What will you do with your pet(s) if you move or migrate? *

What will you do with your pet(s) if you move out / start a family? *

You are required to spay / neuter the dog. Are you willing to do so? *YesNo

Are you prepared to accept the financial and personal responsibility for a pet? *YesNo

Are you willing to make the commitment for 10-15 years of this dog’s lifetime? *YesNo

Volunteer you spoke to at the Adoption Drive (where applicable)

I certify that the above information is true and I understand that false information may result in nullification of this adoption. I consent to the collection, use and disclosure of my personal data by Mercylight for the purposes of responding to my adoption. Mercylight reserves the right to refuse an adoption.

Mercylight Adoption Questionnaire

Who will be responsible for: