English Dog Adoption

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Work Phone Number (Daily) *

Area Code Phone Number

Evening Phone Number

Area Code Phone Number

Cell Phone Number

Area Code Phone Number

E-mail *

Age

Occupation *

Average hours out of the home per day *

May we contact you at work? *

Yes No

Do you have any allergies? *

Yes No

If yes, please list your allergies:

Are you expecting a child or planning a family in the near future? *

Yes No In the near future

Partners Full Name

First Name Last Name

Age

Occupation

Hours away from home

Number of Adults (+18 years old) *

Relation to you

Age

Occupation

Average hours out of the home per day

Relation to you

Age

Occupation

Average hours out of the home per day

Relation to you

Age

Occupation

Average hours out of the home per day

Number of children (-18 years old) *

Ages

Does everyone living in the houseold agree to adopt a dog? *

Yes No

Does anyone have allergies? *

Yes No

If yes, please list who and what they are allergic to:

Who:

Allergies

Are you agreeable to a home visit? *

Yes No

What type of dwelling do you live in? *

House Apartment Condo

Do you: *

Rent Own

If renting please provide your landlords full name

Please provide your landlord contact number

Area Code Phone Number

Do you have access to a yard? *

Yes No

How large is your yard?

Is your yard securly fenced? *

Yes No

How high is your fence?

Do you have a pool? *

Yes No

If yes, Is the pool fenced?

Yes No

Is there a dog run near your residence? *

Yes No

Please list all pets you've owned in the PAST.

Name

Breed

Sex

Fixed

19XX - 20XX

What happened?

Name

Breed

Sex

Fixed

19XX - 20XX

What happened?

Name

Breed

Sex

Fixed

19XX - 20XX

What happened?

Have you ever given up any animal? *

Yes No

If yes, please explain the circumstances:

Have you ever euthanized any animal? *

Yes No

If yes, please explain the circumstances:

Please list all pets CURRENTLY living in your home.

Name

Breed

Gender

Fixed

Age

Name

Breed

Gender

Fixed

Age

Name

Breed

Gender

Fixed

Age

Name

Breed

Gender

Fixed

Age

Important character information

How are you planning to introduce your new pet to your current pet?

PLEASE CAREFULLY CONSIDER YOUR ANSWERS AS ANIMALS VARY GREATLY IN TEMPERAMENT, PERSONALITY AND ACTIVITY LEVEL.

Please list what type of dog you are looking for to make the ideal match for your family.

Animal Preference #1 *

Name or Reference #

Animal Preference #2

Name or Reference #

Animal Preference #3

Name or Reference #

Breed *

Male/Female/Either *

Age Range *

Weight Range *

Would you consider adopting...

Large breed? *

Yes No Either

Medium breed? *

Yes No Either

Small breed? *

Yes No Either

Pure breed? *

Yes No Either

Mixed breed? *

Yes No Either

Not good with people? *

Yes No Either

Not good with other dogs? *

Yes No Either

Not good with cats? *

Yes No Either

Not reliable with children? *

Yes No Either

Partly or not housetrained? *

Yes No Either

Has seperation anxiety? *

Yes No Either

May have behavioural issues? *

Yes No Either

Exhibits fear, aggression? *

Yes No Either

May have dominance issues? *

Yes No Either

Special needs? *

Yes No Either

Puppy? *

Yes No Either

Adult? *

Yes No Either

Senior? *

Yes No Either

Should the dog show a behaviour that is unfavourable, what will you do about it? *

Is there any unfavourable behaviour that would make you could consider giving up your dog? *

Where will the dog stay when home alone? *

Where will the dog sleep at night? *

How often do you plan on going to the vet? *

What food do you plan on feeding your dog? *

Why do you want to adopt a dog? *

What are your plans for you new dog? *

Pet Guard Dog Hunting Work Emotional Companion

What are your primary reasons for wanting a dog? *

Companion for you Companion for children Companion for other pets Watch Dog Gift

Do you consider your dog a: *

Pet Friend Family Member Other

If you chose other, please explain:

Do you plan to use a crate? *

Yes No

If you chose other, for how many hours?:

Do you realize you may adopt a dog with very little known history? *

Yes No

Are you likely to enrol your dog in obedience class? *

Yes No

Are you prepared to spend the necessary time to accustom your entire family (furry included) to your newest member and vice versa? *

Yes No

Preferred level of exercise with dog? *

Couch Potato Short walks Vigorous walks Long walks Hikes or jogs Other

If other, please explain?

How long a day do you expect to exercise your dog? *

How many walks will you take with your dog each day? *

How long will your dog be home alone on average? *

What amount of time and effort do you want to devote to training your rescue dog? *

Which family members would be expected to assist in home training? *

What are your training objectives? *

What is your definition of training? *

How would you rate your level of Dog owning experience? *

Beginner Intermediate Advanced First Time Owner

If you answered other, please explain?

Many rescue dogs have problems with fearfulness, fear aggression, seperation anxiety and house training to name a few. Would you be willing to work with the dog to give them back structure and security? Please explain how you will do this and what you are willing to put up with: *

Are you aware dogs as all other animals may require expensive veterinary care? *

Yes No

Are you prepared to make the financial commitment for an emergency vet visit or illness? *

Yes No

What veterinary care will you have done for your dog? *

What precautions have you taken should any unforseen circumstances arise where you can no longer care for your dog? *

We are a no kill rescue and we take our work very seriously. Please, when filling out this application and submitting your request to become an adoptive family for one of these Beautiful Souls , remember that you are adoption a sentient being. Dogs are lively, energetic, happy-go-lucky animals. They trust you, are loyal to you, will love you, and look up to you.

... HOWEVER... your new addition to your family may:

be destructive, disobey, be restless, need of rehabilitation, be clingy, shy fearfull, and more.

PLEASE MAKE SURE ADOPTING IS RIGHT FOR YOU AND THAT YOU ARE COMMITTED 100%.

Commitment means, if you start seeing problems arising in his/her behavious, seek expertise. Contact us and we will recommend many tips for you to try. Dogs need love, affection, playtime, quiet time, and axercise. It is imperative that you pay attention to your newest best friend appropriately and accordingly in order to see change in unwanted behaviour. There are many books to help you become more comfortable with dog behaviours as well as many online tools. We will always be there for you if the adoption goes through. Please remember that whatever problems you are having, you may contact us and we will do whatever we can to ensure that your family is at peace, content and remains together.

Some dogs nibble, don't like cats, or other dogs for that matter. Dogs are not allowed in all apartment buildings, but many do allow pets. It just takes effort to find the right places. Do you have hat it takes? Dogs may destroy, chew valuable materials and must eat, play, drink, and sleep. They also unfortunately get sick... Dogs live up to 15 years of age and older.

These beautiful souls cannot be bounced around and around, so please understand; this is a life you are caring for and loving. Treat them as though you have adopted a child and never allow them to be discarded again.

A broken soul looking for security, respect, values, discipline, and LOVE. Are you in this until the end, to see it throuh and adopt a Bell'Anima (Beautiful Soul)?

If you understand all of these traits of a dog, are you willing to work through all of these problems? *

Tell us why you are 100% committed: *

Adoption Fees

Purebred Puppies – $535.00
Purebred Adult Dogs – $485.00
Small Breed Dogs – $485.00
Mixed Puppies – $450.00
Mixed Adult Dogs – $400.00
Senior Dogs or Comapssionate Adoptions- $85.00

Puppies (less than 8 months)
Adults (8+ months)
Seniors (7+ years)

SIGNATURE *

POSITION IN THE HOUSEHOLD *

SIGNATURE

POSITION IN THE HOUSEHOLD

SIGNATURE

POSITION IN THE HOUSEHOLD

SIGNATURE

POSITION IN THE HOUSEHOLD

Please provide at least two references attesting that you are fit to be a good adoptive family. References should not be people who live under the same roof as you.

Vet Reference

Clinics Name *

Veterinarian *

First Name Last Name

Phone Number *

Area Code Phone Number

E-mail

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Reference #1

Full Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Day Phone Number *

Area Code Phone Number

Evening Phone Number

Area Code Phone Number

Cell Phone Number

Area Code Phone Number

E-mail

Relationshipt to potential Adopter *

Reference #2

Full Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Day Phone Number

Area Code Phone Number

Evening Phone Number

Area Code Phone Number

Cell Phone Number

Area Code Phone Number

E-mail

Relationshipt to potential Adopter

Reference #3

Full Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Day Phone Number

Area Code Phone Number

Evening Phone Number

Area Code Phone Number

Cell Phone Number

Area Code Phone Number

E-mail

Relationshipt to potential Adopter

Questions, comments, or concerns

Thank you for taking the time to fill out our Adoption Application and being interested in our rescue. Your kindness and generousity are so greatly appreciated.

We hope that we can find you the perfect new addition to your family.

Part I

Part II

Part III

Part IV

Part V

Part VI

Part VII

Part VIII

Part IX