填寫表單，讓我們更了解您！

請問您會是主要照顧者嗎？Will you be the primary caregiver for the animal? *

是 Yes 否 No

務必已「主要照顧者」的資訊填寫

您要申請？What are you applying for? *

領養Adoption 中途Fostering

請問您有對哪隻毛孩有興趣呢？Is there a specific animal you're interested in? *

可以填名字或物種，由送養員協助媒合 Name or species

您是如何知道TSPCA的領養/中途訊息的？How did you learn about our adoption/ fostering program? *

例如協會社群、轉貼文章或送養會等，讓我們更知道哪裡可以多多曝光

請問您有與動物生活的經驗嗎？有的話，若您有與動物生活的經驗，請問您通常是如何陪伴與照顧動物的呢？如果完全沒有相關經驗，填「沒有經驗」就可以喔！What’s the main reason you want to foster/adopt an animal? Have you ever fostered or adopted before? If yes, how do you usually care for them. No experience? Just write “None”. *

例如飼養過哪些物種、飼養多久、日常的相處故事等，請多與我們分享

以下哪些行為會讓您感到困擾呢？Which behaviors might be a concern for you? (Select all that apply)

不親近人 Keeps distance from people 朝人撲跳 Jumps on people 含咬 Mouthing or biting 破壞傢俱 Destroys furniture 翻找垃圾桶 Digs through trash 偷吃人的食物 Eat human food 到處亂尿尿亂便便 Pees or poops in inappropriate places 長期吠叫嚎叫 Constant barking or howling 分離焦慮 Separation anxiety / 過度黏人 Overly clingy

飼養經驗曾經遇過的困擾，或是預期可能會造成的困擾；若沒有在上述選項，也開在電訪時分享

請問您覺得以下哪些狀況需要「立刻」就醫？In your opinion, which of the following require immediate veterinary care?

精神活力明顯下滑 Noticeable drop in energy or alertness 食慾不佳 Poor appetite 24小時未大便 Hasn’t pooped for 24 hours 24小時未尿尿 Hasn’t peed for 24 hours 不明原因開始持續吠叫哭嚎 Has been barking or whining more than usual lately 不明原因開始亂尿尿亂便便 Starts peeing or pooping in unusual places for unknown reasons 散步開始走走停停或時長縮短 Has recently been stopping frequently or taking shorter walks than usual 趴下休息的時長縮短 Spends less time lying down to rest 原本可以觸碰的部位不給觸碰 Refuses to be touched in areas that were okay before 流眼淚流鼻水 Watery eyes or runny nose 抓癢頻率變高 Scratching more often than usual

請針對單一症況

請問您覺得以下哪些狀況發生，可以先觀察「3天」再去就診？Which situations would you observe for a few days before seeking care?

精神活力明顯下滑 Noticeable drop in energy or alertness 食慾不佳 Poor appetite 24小時未大便 Hasn’t pooped for 24 hours 24小時未尿尿 Hasn’t peed for 24 hours 不明原因開始持續吠叫哭嚎 Has been barking or whining more than usual lately 不明原因開始亂尿尿亂便便 Starts peeing or pooping in unusual places for unknown reasons 散步開始走走停停或時長縮短 Has recently been stopping frequently or taking shorter walks than usual 趴下休息的時長縮短 Spends less time lying down to rest 原本可以觸碰的部位不給觸碰 Refuses to be touched in areas that were okay before 流眼淚流鼻水 Watery eyes or runny nose 抓癢頻率變高 Scratching more often than usual

請針對單一症況

請問您知道有哪些方法可以預防傳染病或寄生蟲嗎？Do you know how to prevent infectious diseases or parasites (internal/external)? *

可以分享過去的經驗？或是未來會使用的方法

假設哪天無法再照顧牠了，您會怎麼做呢？（包含人的離世）If one day you're no longer able to take care of your pet (including in the event of your passing), what arrangements would you make? *

會有其他共同照顧人嗎？會採用什麼送養方式呢？會選擇送至公立收容所嗎？

請問您目前的住處是？Do you currently owned home or rental? *

自有Owned Home 租屋Rental

您的房東或社區規定可以養寵物嗎？Does your landlord or community allow pets? *

允許 Yes 不允許 No 不清楚 Not Sure

居住空間的類型是？What type of home do you live in？

套房 Studio 家庭式分租套房或雅房 Shared suite 公寓 Apartment / Condo 社區大樓 Community 透天厝 House(重填)

若選項中沒有，請於電訪時和我們分享

住家總坪數（估算即可） Approximate size of your living space (in square meters/ping) *

請簡單介紹一下目前家中成員和動物的數量（人或動物都算喔！）Tell us a bit about the people and animals you currently live with. (Count everyone!) *

例如同住家人有4位，原本還有飼養2隻貓、1隻鳥

如果您的家中有未成年，請問他們的年齡分別是幾歲？If there are minors in the household, what are their ages?

同住家人是否都同意家裡多一位毛孩呢？Does everyone in your household agree to bring in a new animal? *

是 Yes 不確定 Not sure 目前獨居 Currently living alone

若有不同意的對象，也歡迎在電訪時討論，看看能否解決飼養疑慮

同住家人願意協助一起照顧毛孩嗎？Are they also willing to help take care of the animal?

是 Yes 不確定 Not sure 目前獨居 Currently living alone(重填)

家庭總年收入大約為？Approximate household annual income? in TWD *

500,000或以下 500,001元 ~ 1,130,000元 1,130,001元 ~ 2,260,000元 2,260,001元 ~ 4,230,000元 4,230,001或以上

根據您與家人的生活作息來看，動物每天會有多長時間是獨自待在家的呢？Based on your and your family's daily routine, how many hours a day will the animal be home alone? *

可以與我們分享動物需獨處的時段

您會怎麼準備他每天的餐食和飲水呢？How will you prepare meals and drinking water for the animal? *

餵食水的頻率、時段，也想知道會準備什麼樣的食物內容

如果是照顧狗狗，請問您預計會如何安排牠的散步頻率呢？通常會在哪些時間散步？每次大約多久呢？If you're planning to live with a dog, what kind of walking routine are you thinking about? What times of day would you usually go out, and how long would each walk be?

您打算怎麼安排牠白天和晚上的活動空間呢？How will you arrange their living space during the day and at night? *

請問您能接受動物可能會生病或變老，並且在領養後可能需要負擔較高的醫療費用嗎？Are you okay with the fact that animal might get sick or old someday, and that this could mean high medical bills after adoption? *

感謝您以上填寫，接下來我們在電訪過後會安排家訪，請問您可以接受嗎？We’ll schedule a home visit after a phone interview. Is that okay? *

同意 Yes 不同意 No

家訪的目的是希望可以與您一同打造動物的飼養環境，加速適應；若無法家訪，是否可以在電訪時告訴我們原因呢？

近期方便電話訪問的時段？When is the best time to reach you by phone?

平日 Weekdays 10:00 - 12:00 平日 Weekdays 12:00 - 18:30 平日 Weekdays 18:30 - 21:00 其他，請在備註欄補充

若以上沒有可行的時段，請在下方欄位告訴我們

有什麼想要跟我們說的嗎? Anything you’d like to tell us?

主要照顧者姓氏 Last Name *

主要照顧者名字 First Name *

出生日期 Applicant DOB *

(重填)

e-mail信箱, We will be contacting you through email. *

我們將優先透過電子郵件與您聯繫，請務必確實填寫！

身分證字號 National ID number *

僅用於身份確認，不會外洩 for identity verification only

主要照顧人的聯絡電話 Phone number *

請填寫手機號碼

第二聯絡人姓名/電話/Email/關係 Additional Contact Name/Tel/Email/Relationship *

未避免聯繫不到您，錯失機會，請提供第二聯絡人的資料

居住的縣市 City *

請填寫您與動物會一起居住的縣市

居住的鄉鎮市區 Township/District *

職業 Occupation *

您在這裡

填寫表單，讓我們更了解您！

領養是最棒的選擇!
We're thrilled you're interested in adoption!

您在這裡

填寫表單，讓我們更了解您！

領養是最棒的選擇! We're thrilled you're interested in adoption!

領養是最棒的選擇!
We're thrilled you're interested in adoption!