Register your interest in Adopting a dog
Please note:
To submit an application you must be over 18 years old and will need a valid credit card to pay the processing fee of $25 for your application.
Section 1 - Prerequisites
Are you over 18 years of age?
Yes
No
Sorry, you cannot proceed with the application. You need to be over the age of 18 to formally adopt a dog.
I understand
Is your section fenced?
Yes
No
Please state the materials and height of the fence
Sorry, but you cannot proceed with the application. We require your section to have dog proof fencing as one of the requirements for adopting a dog.
I understand
Do you guarantee the dog will live and sleep inside as a member of the family?
Yes
No
Sorry, but you cannot proceed with the application. Our dogs have been brought up to be companion dogs and therefore need to live/sleep inside.
I understand
Will the dog be left alone for more than 3-4 hours per day?
Yes
No
You can still proceed with the application, however we need more details (e.g. why, how long for, how often)?
Section 2 - Personal Details
Title
Please select...
Mr
Mrs
Ms
Miss
Dr
Prof
Rev
Dame
Sir
Lady
Father
Sister
Brother
Lord
Master
Pastor
The Hon
The Right Hon
First Name
Middle Name
Last Name
How can we get in touch with you?
Home Phone
Mobile Phone
Email
Preferred Contact Method
Please select...
Home Phone
Mobile Phone
Email
What is your current address?
Street Address
Suburb
City
Post Code
Section 3 - Your home
Do you have children living with you?
Yes
No
Please provide details (especially number and age of your children)
Is anyone in your home elderly?
Yes
No
Please provide details
What type of area do you live in?
City
Suburban
Rural
Section 4 - Your experience with dogs
Have you owned a dog previously?
Yes
No
Please provide dog
experience
Please state previous experience with dogs, if any
Do you currently have a dog?
Yes
No
How many dogs, what are their breeds, ages and genders?
Do you own any other pets?
Yes
No
Please state what kind of pets and how many
Section 5 - Your adoption preferences
Are you wanting to adopt a Guide Dog
As a pet
As a companion dog
Please Note: A companion dog is a pet dog for a disabled person who does not require a Guide Dog
Please explain the reasons for wanting a companion dog, and also if this is for yourself or on behalf of someone with a disability
Age preference of adopted dog?
Under 12 months
12 months to 18 months
18 months to 9 years
9 years to 12 years
No preference
Acceptable medical conditions and associated ongoing costs of adopted dogs?
Arthritis (elderly/retired dog)
Eye problems
Hip or elbow dysplasia
Skin problems
None of the above
What gender of dog would you consider?
Female
Male
Either
What are your breed preferences?
Labrador
Labrador Cross Golden Retriever
Golden Retriever
Standard Poodle
No Preference
Payment Information - Processing Fee
Please note:
Blind Low Vision NZ request you pay a processing fee with your Application of $25 via Credit Card. Your credit card will be charged on form submit and the amount is non-refundable. If the transaction is not successful, the application will not be submitted.
This fee does NOT guarantee that you will receive one of our dogs.
If you are successful in adopting a dog, an additional adoption fee will apply to a maximum of $1,500.
I agree
Name on Card
Card Number
Expiry Month
Expiry Year
CVC Code
The CVV/CVC code (Card Verification Value/Code) is located on the back of your credit/debit card on the right side of the white signature strip; it is always the last 3 digits in case of VISA and MasterCard.
x
Billing Email
Before you submit your request
Where did you hear about us?
Please select...
Blind Low Vision NZ website
Email from Blind Low Vision NZ
From a friend or family member
From a fundraising campaign
From a medical professional
In the post
Newspaper
Radio
Social media
TV
Any other comments or information you would like to give us?
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