Rehoming application form

Name *

First Name

Last Name

Can you confirm that you are over 18 years of age? *

Yes

Are you happy to home an MCC Ambassador dog? *

Yes

No

Would the dog ever be left for more than 4 hours at any time? *

Yes

No

Is there children living at the home or regularly visit? *

Yes

No

Do you have any other dogs? *

Yes

No

Do you own any other pets? *

Yes

No

Would you consider a dog with a health condition? *

Yes

No

Not Sure

Would you consider a dog with a behavioural issue? *

Yes

No

Not Sure

Are you able to finance insurance, payment for feeding and any required treatments for dogs including routine vaccinations? (Annual vaccinations, Kennel Cough, Anti-parasite treatments) *

Yes

No

I would like my dog to be a My Canine Companion Ambassador Dog

Yes

No

I am happy for my contact details above to be given to other MCC volunteers in my local area

Yes

No

I would be happy to take my dog to a school visit if I don’t have to give a speech/ talk

Yes

No

I would be happy to give a talk in a school with my dog

Yes

No

I would be happy to visit a business or company in my local area with my dog

Yes

No

I would be happy to attend fundraising and/ or awareness events with my dog in the local area

Yes

No

By completing and submitting this application, you are confirming that the information provided herein is complete and accurate and that you consent to My Canine Companion for the storing of this information for the purpose of this application. Please note completion of application form is no guarantee of receiving a dog. *

I agree