Section 1 : About you...

* What is your name?

* What is your year of birth?

* What is your nationality?

What is your visa status in Japan (if applicable) ?

* Your e-mail address

* Please type that same email address again

Your mobile phone email address.

* What is your full home address?
If the animal you are rehoming is kept at a different address, please write that too.

* Main mobile phone number

Home phone number

Emergency contact number

* Are you a breeder, or do you trade in animals?

Yes
No

... if yes, please explain.

Section 2: About the Animal...

... if other, please specify

* What is the breed, age and sex of the animal?

* Are you the owner of the animal?

Yes
No

If not – who is?

* Tell us about how the animal came into your hands.

* Please tell us in detail why you are trying to rehome this animal.

* Has the animal seen a vet?

Yes
No

If not why not?

* What is the name of the vet?

* What is the URL of the vet's homepage?

* What is the telephone number of the vet?

* Do we have your permission to talk to your vet about the animal?

Yes
No

* Has the animal been bloodtested? (SNAP or equivalent FIV/FeLV for cats, ??? for dogs.)

Yes
No

If yes, what was the result – if no, why not?

* Has the animal been neutered/spayed?

Yes
No

If yes, do you have a vet's bill or certificate that shows the procedure has been done?

If not – please explain why not.

* Has the animal been vaccinated?

Yes
No

If yes, do you have vaccination certificates?

If it has not been vaccinated, please explain why not.

* What is the health and condition of the animal?

* Does the animal have any behaviour issues?

More about you...

* Do you have moral objections to vaccinating animals?

Yes
No

If yes, please explain.

* Do you have moral objections to neutering/spaying?

Yes
No

If yes, please explain.

* Do you have moral objections to microchipping animals?

Yes
No

If yes, please explain.

Section 4: Recouping Expenses...

If you intend asking an adopter for expenses for testing, vaccinating neutering or microchipping, please explain what and how much.

Do you have receipts for the above that you can show us? Please list, item by item.

Section 5: Other information

Please add any additional information you would like us to consider.

Section 6: Agreement

* 1: I will neuter/spay the animal if old enough, and if not, rehome with a strict neutering/spaying agreement.

Yes
No

* 2: I will vaccinate the animal, appropriate to its age, and rehome with a vaccination agreement for any vaccinations that are pending.

Yes
No

* 3: I will microchip the animal, if old enough and rehome with a microchipping agreement if not.

Yes
No

* I will research any potential adopter thoroughly. I will check the conditions under which the animal will be kept and make a real effort to assess the suitability of applicants and rehome the animal appropriately.

Yes
No

* I am the owner or guardian of this animal and am legally permitted to rehome it

Yes
No

* I am 21 or older.

Yes
No

* I have good Japanese language skills OR I have a native Japanese speaker who will assist me

Yes
No

* I certify the above information is true.

Yes
No

* Please type your name to indicate your agreement to the above:

* Please type the code on the left into the field on the right, to prove you are a real person. You can also click the speaker icon to have the code read out.

[ Unreadable? Click for different code. ]