Adoption request form in English Name * First Name * Address * N°, Rue, Lieu dit ... Code Postal * Town * Home phone no * Mobile phone no Email address * Your demand for adoption concerns : * A cat A dog OtherOther Date of birth Start with the year then month and finally the date You live in : * An appartment A house OtherOther Do you have a garden ? * Yes No OtherOther Area of the garden ? * Is it secure ? * Yes No OtherOther How many people in your Household? * Do you have Children ? * Yes No How old are they ? * In case of Health problem with your pet, would you be able to afford the Vet fees ? * Have you ever had a dog ? * Yes No What breed ? For how long ? .. * Have you ever had a cat ? * Yes No What breed ? For how long ?... * Do you have animals in your home ? * Yes No Which ones ? * They are : * Electronic chipped or tattooed Vaccinated every year Sterilized Other What is your reason for wanting to adopt ? * What animal are you interested in adopting ? * If we entrust an animal to you, how long during the day would it be alone ? * Where will the animal be during your absences (shopping, work etc) ? * If inside, where will it be? If outside where and what space will it have? ... Where will it be when you are at home ? * Where will the animal sleep, be precise ? * Who will be the carer ? * Where will the animal be when you are on holiday ? * Boarding kennel Friends Family OtherOther Are you able to collect your animal from the refuge or a Foster Family ? * Yes No OtherOther Please indicate your level of French * Where did you hear about Association Galia ? * Google, Facebook, Le Bon Coin, word of mouth ...? Thank you ! Please verify you have received a confirmation email at the address you have entered, an english speaking volunteer will contact you shortly. Si vous êtes un humain, ne remplissez pas ce champ.
