NPC(2015/397299/08)

Diann v Heerden C:083 419 9110

Michelle Zerbe C: 071 365 3273 EMAIL ADDRESS: pekingesehaven2015@gmail.com
Michelle Lennard C: 082 410 1822

Office Use
Approved: YES/ NO
Inspector: ………………….
Date: ……………………….

ADOPTION APPLICATION
Please complete and return electronically or email to pekingesehaven2015@gmail.com or fax to
0866219546 or hand in personally or any of the above mentioned email addresses.

PLEASE NOTE: We are cautious about rehoming Pekes in homes with large breed dogs.
Every situation will based on merit

1. PERSONAL DETAILS of applicant.

Full names of applicant: Jean-Pierre Pretorius

ID Number: …7409035063086………………………………………………………………….. …….

Occupation: Graphic Designer

Employer: African Sky

Physical Home Address: 6 Trevonia Mews, Harold Kitson Crescent, Garsfontein 0042 Pretoria

Postal Address: PO Box 1075, Garsfontein, 0042

Cell No: 0833842829

Home No: 012 36 111 49 Work No: same as home

E-mail: sixstringtechnician@gmail.com
 PEKE EXPERIENCE

2.1 Have you ever owned a Peke before? Yes  No 

If NO – why are you interested in owning one now?

N/A Applying for Mac and Meg
2.2 Do you know that Peke snore and shed hair 365 days a year and want to be with
you all the time? Yes  No. Comments?
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2.3. If you have owned a Peke previously or you currently own a Peke, please supply
further information.

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3. OTHER ANIMALS IN THE HOUSEHOLD
3.1 What other breed of animals do you own and what are their ages and sex?
Male Biewe Yorkie – 2 years old
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3.2 Are they sterilized and up-to-date with their annual vaccinations?
yes………………………………………………………………………………………………
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3.3 How do you care for these animals? Our pets are well cared for and loved. I have
2 children and the dog is often taken for walks and goes with on family outings. Our pets
are allowed on beds and couches and sleep in our room. He is often taken for grooming
and he gets baths at home when in need with the right shampoo
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3.4 What happens to these animals when you are at work or go away on vacation? I
work from home and if we go away we get somebody to stay at the house. Usually a
good
 friend.……………………………………………………………………………………………
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3.5 Have you ever surrendered any of your animals to the SPCA or any other animal
welfare centre and for what reason?
no………………………………………………………………………………………………
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4. ADOPTION PREFERENCES
4.1 What age group would you consider adopting? ………………………..
4.2 Are you interested in a male or female? Why?
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4.3 Would you consider adopting a pair? Yes/No.

Would like to adopt Mac and Meg
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4.4 Colour preference? Fawn/Black/Brindle/Anything n/a………………………………..

4.5 Would you consider another breed of dog or a peke-cross? Yes/No/Maybe.

5. CONTRACT RQUIREMENTS.
Are you prepared to sign the Pekingese Haven Contract which asks you to:
5.1 Keep the Peke healthy and take him/her to the vet when necessary? Yes
5.2 Return the Peke to Pekingese Haven should you no longer be able to keep the
Peke for any reason? Yes
5.3 Make a donation to Pekingese Haven to cover any costs involved in the rescue,
rehabilitation & re-homing of the Peke? (approx R950.00 which covers sterilization,
inoculation, dentals, de-worming, ears flushed, nails clipped, folds cleaned, micro-
chipping & dipped) Yes  No 
5.4 Add an addendum to your will which gives instruction regarding the returning of
the Peke on your death to Pekingese Haven ? Yes  No 
6. HOMELIFE OF YOUR PEKE
6.1 Where will the Peke sleep at night? Inside our bedroom, usually on the
bed...............................................................................................................................................
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6.2 Where will the Peke stay when you are at work, on holiday, and/or away over
weekends?
I work from home and am here 90% of the time
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6.3 Can the Peke be secured away from moving vehicles on your property?
Yes...............................................................................................................................................
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6.4 Will the Peke be part of your family or left outside? Explain.
Our pets our treated like one of the pack 
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6.5 What will you feed the Peke? Proper vet food
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6.6 Where will the Peke be kept during the day? Inside with access to outside as I am
home............................................................................................................................................
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6.7 Is your property securely fenced to keep the Peke secure? Yes, its a solid brick
wall..............................................................................................................................................
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6.8 Have you ever had parvo on your property and stipulate date? Yes  No .
Explain.
No................................................................................................................................................
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7. RESIDENTS

7.1 Do you and your partner both work full day? I work from home
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7.2 Do you have young children? Yes No. If so what are their ages & gender? Girl and boy,
aged 11 an
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7.3 Give details of any other persons living on your property or staying at home.
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7.4 Details of domestic workers and/or gardeners and/or garden services that come & go during
the week? Monday and
thursdays……………………………………………………………………………………………
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8. RESIDENCE.

8.1 Do you plan on emigrating? no

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8.2 Do you own your home or rent?
Owner…………………………………………………………….
8.3 If you rent do you have permission from the landlord to own pets? yes
8.4 Do you have a swimming pool or pond? No
8.5 Is the pool/pond covered or fenced securely to prevent access? Yes  No . Details?
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8.6 If the pool is not covered can the Peke be secured away from the pool? Yes  No .
Details?
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8.7 Are you prepared to have your home inspected? Yes
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8.8 If ‘yes’, best day & time to conduct a home inspection? I am home most
days……………………………………………….
8.9 Name and contact details of your current vet? Faerie Glen animal
clinic……………………………………………………………………………………………………
……… Do we have your permission to contact your vet for a reference? Yes

8 REFERENCES. Name and contact details of two references we may contact:

9.1 Full Name: …………………………………………………………………………………………

Relationship:……………………………………………………………………………………………
Cell : ………….……………………………… Home/Work tel: …………………………………

9.2 Full Name: ………………………………………………………………………………………

Relationship:…………………………………………………………………………………….
Cell: ………….……………………………… Home/Work tel: ………………………………
10. ADDITIONAL INFORMATION you believe we need to know to support your adoption
application?
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If I am approved to adopt a Rescue Peke I undertake to care for the Peke, to treat him/her as a
family member for the rest of his/her life (Pekes can live to 14 years of age). If my circumstances
change and I am unable to care for the Peke in any way I will return the Peke to Pekingese
Haven NPC(2015/397299/08). I will sign & abide to all aspects of the Adoption Contract.

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SIGNATURE 1 DATE

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SIGNATURE 2 DATE

PEKINGESE HAVEN SOUTH AFRICA N P C (2015/397299/08)