90 BOFORS CIRCLE P.O. BOX 59 STANDARD BANK SACKS CIRCLEEPPING 2 RONDEBOSCH 770107 146 5820 BELLVILLE SOUTH021 534-6426 T NPO 000 561 RONDEBOSCH 021 951-3010 T086 550 0979 F PBO 93 000 6848 025 009

adoptb@aacl-ct.co.za adoptE@aacl-ct.co.za

ADOPTION APPLICATION FORM – DOGS/PUPPIES

Please note the following criteria with regard to the Adoption process.

You must be at least 21 years of age. Have the consent of your landlord and body corporate (if applicable). Be willing and able to spend time and money to provide training and necessary vet care. Agree to pre- and post home checks by our inspectors. The adoption fee includes the 1st vaccination, de-worm, frontline and sterilization. Entry into the kennels is purely at your own risk.

FEE: R550.00

Full name and surname …Hanlie van Zyl………………………………………………………………………………...

Physical address …110 Joubert st Protea Heights Brackenfell………………………………………………………………………………………..

Tel: (H)9810623 .................................. (W) ……………………………… (C) …0761396116………………………………..E-mail address: …vanzylhanlie1@gmail.com………………………………………………. ID …6902210070083…………………………………Do you have any children? ……y………. If yes, state their ages: 11 and 24………………………………………...Type of dwelling (please circle): House / Townhouse / Flat / Farm / Live with relative or friend / OtherIs the property fully enclosed and locked? y…………. What is the fence made of? vibacrete……………………...Size of property? …Large………… Size of enclosed section? …large…….….. Height of fence? 2m………………...Do you have a swimming pool? …no………. Is it enclosed? ………………………………………………

Please list the pets you have at the moment:BREED SEX AGE STERILIZED NO. OF VACC’s

1) …none………………………………………………………………………………………………………2) …………………………………………………………………………………………………………3) …………………………………………………………………………………………………………

If your animal is not sterilized, please provide a reason: …………………………………………………Have you ever had a pet euthanized? …no……… Please explain: …………………………………………Have you ever surrendered a pet to a shelter? …no……… Please explain: ………………………………..Have you ever had a pet go missing? no………….. Please explain: ………………………………………..Do you agree that a dog should wear a colour and ID tag at all times? …yes………………………………..Have you had an animal, in the last 3 months, on your premises with Parvo / Distemper / Feline leukaemia / FIV / Mange or any other disease? ……no……………………………………………………..Please give the name and contact number of your Veterinarian: …don’t know yet……………………………………....Describe in detail the type of dog you want: …Dolce and Cabanna or Rolo…………………………………………………………..Reason for wanting a dog (please circle): Companion / Pet / Watch dog / Gift / Breeding / Guard property / Friend for existing pet / Other (please specify): ……………………………………………….

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Where will the dog sleep? …in the house………………………. Are you prepared to exercise the dog? yes…………Will the animal have access to water and shelter at all times? …yes……………………………………….What type of shelter (please circle): Kennel / Braai room / Patio / Garage / Wendy house / OtherWill the dog be tied up or be free to run in the garden? …no………………………………………………What brand of food do you feed your animal(s)? …Pedigree……………………………………………………..How often would feeding take place? …twice a day…………………………………………………………………Is there somebody home during the day, if yes, who? …Yes, Hanlie van Zyl…………..………………………………….…How many times have you moved in the last 5 years? Once…………………………………………………..If you move, what will you do with your pets? …Take them with……………………………………………………….When you go on vacation, what arrangement do you make for your pets? …family arrangements…………………………..

Do you understand that your animal(s) must be vaccinated yearly, de-wormed at least every 3 months and treated regularly for fleas and ticks at your own expense? …yes……………………………………….To ascertain whether you are able to provide necessary veterinary care please complete the following:I am currently employed (company name and job) …Housewife…………………………………………………..Self-employed (please specify) ……………………….. / Pensioner / student / State subsidised / Receive an allowance / Other (please specify) ………………………………………………………….

PLEASE NOTE

This application form needs to be completed before you are allowed onto the premises to view the animals. If any of the above information is left out or improperly filled in, the adoption process will be delayed until all the required information is obtained.

Animals adopted from the AACL, if found not to be suitable for any reason, may not be handed on but must be returned to the League. The AACL has the right to inspect the animal at any time and if conditions are found not to be suitable WE RESERVE THE RIGHT TO REMOVE THE ANIMAL

Signature: ……H. Van Zyl……………………………………. Date: 22/04/2013………………………………………………

OFFICE USE ONLY

Adoption Officer: ………………………………………….

Name of dog: ……………………………………………… Breed: ……………………………………

ADOPTION NOTES

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Inspector: ……………………………. Date:……………………...Property passed / failed / pending

Inspector’s Comments: …………………………………………………………………………………………….…………….....……………………………………………………………………………………………………………..……………………………………………………………………………………………………………..……………………………………………………………………………………………………………..……………………………………………………………………………………………………………..