PHONE NUMBER - Please enter carefully as we will be unable to contact you otherwise. *
FIRST NAME *
SURNAME *
EMAIL ADDRESS *
Please enter in which county you are in to help us to plan your home check. *
Not Answered
Antrim
Armagh
Carlow
Cavan
Clare
Cork
Derry
Donegal
Down
Dublin
Fermanagh
Galway
Kerry
Kildare
Kilkenny
Laois
Leitrim
Limerick
Longford
Louth
Mayo
Meath
Monaghan
Offaly
Roscommon
Sligo
Tipperary
Tyrone
Waterford
Westmeath
Wexford
Wicklow
Not in Ireland
Street Address *
Name of town or village *
Any other directions you can give to help us plan your home check *
Are you interested in a specific dog or dogs? *
Not Answered
Yes
No
If yes, please enter the name of the dog you are interested in. *
Are you looking for a specific breed of dog?
Not Answered
Yes
No
If yes, please state your preferred breeds.
How many people live in your home? *
Will the dog be living with, or in contact with, children? *
Not Answered
Yes
No
If yes, what ages are they?
What kind of accommodation do you have? *
House
Townhouse
Apartment
Other
Do you own your own home? *
Not Answered
Own my home
Rent and have Landlord's written Permission
Rent and don't have Landlord's written permission
Do you have a fenced yard, dog run or neither? Please describe your set up. *
How long have you been thinking about acquiring a dog? *
Is any one in your home allergic to animals? *
Not Answered
Yes
No
Has every one in the household discussed adopting a new pet? *
Not Answered
Yes
No
Will someone be home during the day? *
Not Answered
Yes
No
Why are you looking for a dog? (Security, companion, company for other pet, etc…) *
How long will the dog be left alone during the day? *
Where will the dog sleep? *
Where will the dog spend the days? *
When was the last time you had a dog?
If you had a dog before, what breed was s/he?
What happened to the dog?
Do you have a dog or dogs at the moment? *
Not Answered
Yes
No
If yes, please tell us their breed, sex and ages.
Was your previous dog / are your current dogs neutered?
Are there other pets in the house? *
Not Answered
Yes
No
If yes, please state what type.
This dog is desired for: *
Not Answered
Individual
Couple
Family
Who will be ultimately responsible for the dog? *
How and how often, do you plan to exercise your dog? *
Do you plan to obedience train the dog, if so, how? *
Please describe what energy level of dog you are looking for: *
Not Answered
Low
Low/Med
Med
Med/High
High
Expectations of behaviour? What would its personality be? *
What age of dog are you thinking of?
Not Answered
Don't mind
Under a year
1-4 years
4-8 years
Senior dog
What size of dog are you thinking of? *
Not Answered
Don't mind
Tiny
Tiny - Small
Small
Small - Medium
Medium
Medium - Large
Large
Large - Extra Large
Extra Large
What kind of coat should your dog have? *
Not Answered
Don't mind
Long coat
Medium coat
Short coat
Low-shed coat
How much grooming are you comfortable with? *
Not Answered
Don't mind
Daily
Once a week
Occasional
What level of training would you like? *
Not Answered
Don't mind
Fully trained
Needs some training
Like a challenge!
How active would you like your dog to be? *
Not Answered
Don't mind
Very active
Moderately active
Couch potato
Where do you want your dog to spend their time?
Not Answered
Don't mind
Live mostly outdoors
Indoors and outdoors
Live mostly indoors
What level of house training would you be comfortable with?
Not Answered
Don't mind
Fully house trained
Nearly there
Willing to start from scratch
I agree to MADRA using my personal information in accordance with the Privacy Statement outlined on their website. *
No Yes
Thank you so much for taking the time to fill this out, it really helps us to find the right companion for you! Please press the submit button to submit your form. You will be redirected back to the home page after submitting.