90 BOFORS CIRCLE P.O.

BOX 59
STANDARD BANK SACKS CIRCLE
EPPING 2
RONDEBOSCH 770107 146 5820
BELLVILLE SOUTH
021 534-6426 T
NPO 000 561
RONDEBOSCH
021 951-3010 T
086 550 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

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Physical address 110 Joubert st Protea Heights Brackenfell
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Tel: (H)9810623
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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 / Other
Is 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 VACCs
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:

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Have you ever had a pet go missing? no.. Please explain:
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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: dont 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): .
- 2 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 / Other
Will 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.
22/04/2013

Date:

OFFICE USE ONLY

Adoption Officer: .
Name of dog: Breed:
ADOPTION NOTES

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

Inspectors Comments:
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