Please send to your answers for the following form if you wish to adopt a dog.

Name of the dog(s) or cat(s) that you are interested in : 

Your contact details
Family Name :
First Name :
Date of Birth :
Full Address :

Postal Code:
Home Number :

Mobile Number :
Email Address :

What kind of home can you offer the dog

A House: With a fenced garden With an unfenced garden No garden

A flat

Could you tell how long would the dog be staying alone at home
If you go on Holiday or if move to a different country what will you organise for your dog ?

How many children are in your home:
What ages ?
Have they ever lived with a pet ?

Dogs that you own
Breed :
Sex :
Age :

Yes No

Other :

Knowledge about dogs

Have you already experienced adopting a dog or is it your first dog ?
Why did you chose to adopt a dog? Please feel free to add any other comment you have not yet had
the chance to share with us?
How did you hear about Chiens d'Ici et d'Ailleurs ?