Charlie's Legacy Adoption Application

Charlie's Legacy Dog Rescue Adoption Application
Is there a specific dog you are interested in?
Your Name
Address
City
State/Province
Postal Code
Phone number
Email
example@example.com
Date of birth

MonthDayYear
Date
Place of employment & position
Number of years with employer
Number of adults/kids in the home (please list their ages)
Have you ever owned a pet before? If they are no longer with you, please explain why.
Please list the names, ages, and species of the animals currently in your home.
Please confirm they are spayed/neutered, current with vaccinations and on monthly flea preventative/heartworm preventative.
Name of vet office and their phone number, or whatever vet you've used in the past with previous pets. (Please let your vet office know it is okay to talk to rescues about your pet ownership history.)
Home type:

HouseApartmentCondoOther
Do you own your home or rent? If you rent, are there any breed/weight restrictions for a pet? Please include your landlord's name and phone number.
Will the pet live inside your home? Somewhere else?
Who will be primary caregiver?
Are you financially able to provide the adoption fee, adequate food and shelter, annual vaccines,exams and monthly heartworm/flea/tick prevention, additional vetting in case of illness/injury, grooming and obedience training?
Is anyone in the household allergic to pets?
Has anyone currently living in the address above ever been charged with or convicted of animal neglect, cruelty/abuse, or domestic violence?
Have you or anyone in the address above been denied to adopt by another rescue organization or animal shelter? If so please explain.
Have you or anyone in the address above ever had to surrender an animal to the humane society or animal control? If yes, please explain.
Please describe your yard/outdoor area and fence type (if applicable).
How do you plan to handle taking your pet outside? (fence, long leash, e-fence, etc)
Where will your pets stay if you are hospitalized or go on vacation?
Where will your pet sleep at night?
Do you plan to crate train?
Work schedule (days/hours)
Your lifestyle: Check all that apply:

Homebodyactive outdoorsrunning from event to eventlots of visitorshardly ever home
How long will the dog be alone when you are out of the home for work? If gone six or more hours a day, can someone come in mid-day to let dog out?
What type of exercise will you provide this dog?
Which of the following problems are you WILLING to work on?

Separation anxiety?Mild aggression?House training?Reaction to other dogs?Vocalization?Excitability?Obedience?Fearfulness?Barking?
Problems you would NOT be willing to work with? Please list
Please share a few pictures of your current INDOOR living area, and also your current backyard. (We ask this in lieu of a home visit to make sure it's a safe environment for a pet. If you have trouble uploading pics, it's no problem! We will text you after you submit your application, and you can send pics through text message.)

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Please list two references (one co-worker and one other reference who doesn't live with you) who can attest to your character and responsibility. Please include their names and phone numbers, and don't forget to give them a heads-up that we may call.
If you have any additional information you would like to include, or any questions, feel free to write them here!
Thank you so much for applying! Please be patient with us and we will give you a phone call within the next few days. We are looking forward to speaking with you!
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