Dog Adoption Application (CPL) 526

Dog Adoption Application

CanineProtectionLeague.com
Friendly Note to Applicant: Our application is designed with one purpose; to protect the companion animal that has come into our care. We require completed application, home inspection & family interview. Please be sure to fill it out in detail and not skip anything. All answers are strictly confidential used by us to ensure a good match for our beloved rescued pets.

We strive to make sure we match each of our dogs with the best suited home possible. If you don't have a particular pet in mind that's okay, We are matchmakers committed to helping our applicants and our dogs find the perfect match. We will consider your information "match" you....Of course if there is no "chemistry" between you and the pet/s we suggest you are under no obligaiton to adopt...

The first step to getting approved is subbmitting a completed application, & a copy of lease, HOA agreement, or proof of home-ownership, we want to make sure that pets allowed where you live, We do not want our pets "snuck" into a home where when "landlord catches you" you are given the boot! We do not want you or our beloved rescued pets homeless! We also request when submitting an adoption application kindly make a donation to help us keep the website, online form service and dog rescue going... Every penny donated goes to the dogs, we are volunteers. Donations can be made here

Next, Please give us time to do a thourough application fact verification, veterinarian & personal reference check, we will then setup and do a home visit to meet your family, and make sure things are safe for a dog... When all of the above is an order a meet and greet with the dog & potential adoption appointment will be set up for you in Southern VT.

Proof of home ownership and / or copy of lease and or HOA pet policy should be attatched to this form (where it says upload).. Applications submitted either Incomplete, without proof of homeownership/ lease will be rejected. Please be sure you do not skip anything,on form if an answer does not apply type NA (not applicable).

A successful adoption depends on selecting the right dog for your household and a good understanding of the dog's needs and care requirements. Please help us with this process by answering the following questions honestly & completely to the best of your ability. Let's Begin!
PRIVACY NOTICE: Your privacy is very important to us. In order to assist you Canine Protection League gathers Information from you strictly on a voluntary basis, this information includes but is not limited to your name, address, email, and phone numbers. CPL may collect this and other personal personal information if you fill out a contact form, application, request information from us, make a donation, sign-up to join our eMail list, etc. Except as permitted in this privacy policy, we will never sell, transfer, give, exchange or rent your personal information to any other party or organization without your explicit permission, nor will we send mailings on behalf of other organizations. The only exception on releasing personally identifiable information is if we believe it is necessary and appropriate to comply with applicable laws or regulations, and/or to protect the rights, property, or safety of Canine Protection League Incorporated, the pets we rescue, our volunteers or others. CPL reserves the right to make changes to this privacy policy. If CPL makes a material change to this privacy policy and /or related practices, including how we collect and/or use personally identifiable information, we will indicate this on this form and or our website that our privacy policy or related practices have changed and we will provide a link to our new privacy policy, We encourage each visitor periodically to review this policy to ensure that you will know what personally identifiable information CPL collects, How it may be used, as well as to keep you current as to revisions and/or changes to this policy. Thank you for your support of our mission and interest in adopting from Canine Protection League.
Name of Dog Applying to Adopt (write "match-me" If you want help selecting)*
Please Describe Dog; include Breed, Sex, size, color*
My Name*

First NameMiddle NameLast NameSuffix
Age *
Drivers License number and state of issue*
Do you own your own car? *
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mobile Phone*

Area CodePhone Number
Home or Landline Phone*

Area CodePhone Number
Your Direct Work Phone

Area CodePhone Number
Personal E-mail*

Confirmation Email
Are you Currently Employed? *
Name of Employer
If Not Currently Employed, Why Not?
Work - Alternate Email (*If working this answer required, otherwise ignore)

Confirmation Emailexample@example.com
Current Employer (**if working must complete all areas, failure to disclose will nullify application**)

Company Name & Street Address

Street Address Line 2

CityState

Zip Code
Your Position/ Tittle /Certification/ (**answer required if working, otherwise ignore)
Hours worked per day/week (**answer required if working, otherwise ignore)
Supervisor's Name (**answer required if working, otherwise ignore)
Supervisor's Phone (**Must Include if working)

Area CodePhone Number
Education: High school, Vocational -Technical HS, Trade School, Vocational / technical college, Associates, Bachelors, Masters, Doctorate etc.*
Highest Degree Earned*
Our goal is not to turn you down, but to match our rescued dog to the home most suited for it's individual and unique personality, age, energy level, history etc.

So we can best match our pets to the most well-suited homes we require applicants list every adult, child and Pet that lives in this household, including both full-time & part-time occupants.

Therefore, failure of applicants to list every home occupant, or omit or falsify info on this application will result in a rejected application, or an annulled adoption if the discovery of omission or falsification is made post adoption, accordingly, if adoption is annulled, then any adopted animal will be siezed by Rescue, without refund.

The dogs deserve our very best, So please, be honest.
Co-Applicant Name (This would be your spouse, GF, BF, parent, adult child )*

First NameMiddle NameLast Name
What is your relationship to Co applicant?
Co-Applicant's Relationship to you*
Husband, wife, fiancé, boyfriend, girlfriend, roommate, Parrent, aunt,
Age *(Required if you have a co-applicant)
Co-Applicant Mobile Phone *(Required if you have a co-applicant)

Area CodePhone Number
Work Phone (**if Co-applicant works this is required**)

Area CodePhone Number
Co-Applicant’s Email (*Required if you have a co-applicant)

Confirmation Email
Drivers License number and state of issue (Required if you have a co-applicant)
Does co applicant own their own car?(Required if you have a co-applicant)
Highest grade co-appl completed in school ((Required if you have a co-applicant))
Co-Applicant Work Email (if Co-applicant works this is required)

Confirmation Emailexample@example.com
Are their others living in the house?*

YesNoPart time Shared child or Elder Care/CustodyPart time or full time Nurse, health care worker, maid, Nanny, personal assistant etcParent(s)GrandchildrenRoom-matesOther RelativeFoster ChildOther
Children Under 18 Years Old Living in Home We need to be sure dog is a good fit for all who lives there. We are very good detectives so be sure you are honest here. ** Applicant Must include ALL full time and ALL part time residents **Failure to disclose all of the people living in home will result in rejection of application or nullification of adoption & seizure of dog by CPL**
Child Living in Home (This includes full time, Part time, and seasonal, Failure to include all will result in rejection of applicaion or nullification of adoption)
Child Living in Home (This includes full time, Part time, and seasonal, Failure to include all will result in rejection of applicaion or nullification of adoption)
Child Living in Home (This includes full time, Part time, and seasonal, Failure to include all will result in rejection of applicaion or nullification of adoption)
Child Living in Home (This includes full time, Part time, and seasonal, Failure to include all will result in rejection of applicaion or nullification of adoption)
Child Living in Home (This includes full time, Part time, and seasonal, Failure to include all will result in rejection of applicaion or nullification of adoption)
Adults 18 Years or older Living in Home

We need to be sure dog is a good fit for all who lives there. We are very good detectives so be sure you are honest here. Applicant Must include AlL full time and ALL part time residents Failure to disclose all of the people living in home will result in rejection of application or nullification of adoption & seizure of dog by CPL .
Additional Adult Living in Home (Required if you have a co-applicant **Failure to include all will result in rejection of application or nullification of adoption)
Additional Adult Living in Home (**Failure to include all will result in rejection of application or nullification of adoption)
Additional Adult Living in Home (**Failure to include all will result in rejection of application or nullification of adoption)
Do you have any employees that work at the house such as Home health aides, RN, Nanny, Landscapers, Housekeeper, Personal Assistant? If yes what is their position and schedule?*
If you have any employees that work at the house have you discussed dog adoption and care with them? What will you do to ensure that they treat the dog properly and do not let it loose or cause any harm to come to it ? (required if you have employees at the home)
Do you currently have any pets?*

YesNo
If you currently have pets in the home, please list them below, MUST include: Each pet's name, species, breed, sex, age, color, spayed/neutered. (failure to list all the pets living in the home will result in a rejected application or if omission is discovered after adoption then adoption agreement will be annulled and adopted animal w/be seized and reclaimed by rescue immediately)
Please list all pets living in your home, even if they belong to another household member. Include name of pet, it's species, breed, age, sex, color and if they are spayed/neutered or not.
SPAY NEUTER : Are all your current pets spayed or neutered ?*

YesNoI do not have any pets right nowClick here if you are NOT willing to have your pet's spayed or neutered.My Prior Pet was Spayed / NeuteredMy Prior Pet was NOT spayed /NeuteredOther
Current pets: Are any of current pet's protective of their home, crate, food, toys, other family members, other pets ? Please give details*
Do your current pets go to the doggie park, attend doggy daycare, or play with family member or neighbor dogs ? Give details
Do you have chickens, cows, horses, pigs, sheep, cats, small indoor or outdoor domestic pets on your property? Details *
Do any of your neighbors with adjoining properties have of any of the above? *
If you Became unavailable due to an Emergency or had to travel without pet, Do you plan on using a boarding facility, pet sitter, neighbor or a family member to watch your new pet? Give Their Information Below. *
Have you applied to adopt through any other rescues*

YesNoIf yes, list name of rescue and date applied in box belowOther
How did you hear about our Rescue group?
When will you be ready to adopt this dog?*

This WeekWithin a couple weeksWithin a monthNot ready yet, just researchingOther
Current Veterinarian Name, Address, Phone Number, Must include Name of person who is listed as responsible party on the vet's account. (IMPORTANT: call your vet and give permission to release information to us) (**Failure to include all will result in rejection of application or nullification of adoption) *
* If you DO NOT HAVE PETS NOW, THEN you Must LIST YOUR PREVIOUS Veterinarian’s Name, Address, Phone Number, ** Must include Name of person who is listed as responsible party on the vet's account**. (IMPORTANT: call vet and give permission to release information to us)*
Emergency / Alternative Veterinarian: Where Have you *Gone Before or Where would you take pet in a *Future emergency if your vet was closed? *
If you do not have pet's now what was the Prior Pet's Veterinarian Name, Address, Phone Number, Must include Name of person who is listed as responsible party on the vet's account. (IMPORTANT: call your vet and give permission to release information to us)
Vet name, address & phone number
When did you first begin using this veterinarian & When was your last visit there? *
Emergency / Alternative Veterinarian Name, Address, Phone Number, Include Name of responsible party listed on pet's account at veterinarian office. (please call your vet and give permission to release information to us)*
Include the Vets names, addresses & phone number
Professional Pet References: List Current or Previously Utilized Professional Pet Care Givers; Must List their full Name, business address and phone number & indicate type of services provided, Ie: Groomer, Trainer, Pet Sitter, Dog Walker etc*
Must include the Business and personal names, addresses & phone numbers
List Minimum of 2 Personal or business references, Please DO NOT list your veterinarian, no family, & nor anyone who lives in your home. Please, list persons full NAME, ADDRESS, PHONE, YRS KNOWN, HOW U MET and relationship to them. If you do not have a minimum of 2 references you will not be approved.*
Minimum 2 References- List Name, Address, Phone number, their profession & how aquainted
Are you planning to move in the near future?*

YesNo
Do You Plan on Moving in next 1-5 years? If Yes approximate date and to what city/state?*
Are you looking online/ at rescues/ or shelters for a dog?*

No, I am only interested in this particular dogYes, just an email inquiry, no app yetYes, another application was submittedNot yet, but I am looking and may apply elsewhere if i spot one i like
Have you applied for, had a home visit, or are you schedueled to meet another rescue dog or shelter's dog?*

YesNoOther
If yes, what is name and location of rescue or shelter and when?
Is anyone in your home allergic to dogs?*

YesNoUnsure
Does anyone in your home fear dogs?*

YesNo
Has anyone that lives in your home ever been bitten by a dog? If yes, who was bitten and what were circumstances, When was this? *
Does anyone in your home smoke cigarettes?*

YesNo
What kind of food do you plan on feeding your new dog and how often ? *
Have you ever crate trained a dog?
Do you own a dog crate? If not do you plan to get one for your new dog? *
where will crate be located and when would dog be using it ?*
Some dogs are very strong, can jump up on people, and can be unpredictable at times, because we want everyone safe, Please tell us Is anyone in the home uses oxygen, walker or wheelchair, or if they sometimes have problems with balance or walking independently?*

YesNoIf yes give details In box belowOther
list your home owners association or landlord-lease dog regulations and restrictions:
If you answered no to the question above, please contact your town/county/state/condo assoc and ask them what the regulations are.
What are your city, municipal and state laws regarding owning a dog? *
Did you and your co-applicant have dogs growing up ? Have you ever owned a dog as an adult ? Please give details *
if you’ve never had a dog as an adult before, why do you want want one now? How do you know you’re ready for a dog right now ? *
I live in a*

Single Family HomeDuplex/TwinCondo/Town-homeMobile HomeApartmentMother daughter apartmentOther
Do you rent or own this property?*

RentOwnRent to own written agreementMy Name is on leaseMy Name is NOT on leaseMy name is on Deed/MortgageMy Name is NOT on Deed/MortgageAnother Member of my household is on Lease, deed or mortgageOther
Is there a pool, pond, Lake, Brook, Creek on or adjacent to your property ? *
Is there another dog living on property adjacent to any of your property? *
Renters, have you contacted your landlord to find out if there's any restrictions on the kind or size of dog you can have?

YesNoNot yet, but I willIt's written in our leaseNot applicableOther
Approximate square footage of your home*

Less than 800 square feet800-1,000 square feet1,000-1,500 square feet1,500-2,000 square feetOver 2,000 square feet
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, but no fenceHave yard but Fence not needed, will train dog to stay in yardYard with dog runner or tie outNo yard (apartment/condo/town-home)I have a yard and will use a chain to contain dogOther
If you do not have a fenced yard how do you plan on exercising and toileting the dog ?
List situations where it be OK to have the dog outside without a leash or a fence ?
If home has vertical fence, what is your fence height?

4' high5' high6' highOther
If yes how do you plan to keep your pet safe ?
Do you work outside the home?*

YesNoOther
If you and your co-applicant both work outside the home, how many hours per day are you away?
How many hours per day will this dog be alone? Please explain.*
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.No, keeping it secret because pet is a gift or surpriseOther
Based on the description in the dog's bio, do you feel pretty confident that you will be likely to adopt this dog upon meeting it?*

YesNoNot sure
Upon meeting the dog, what would give you cause to not want to adopt it? Please explain.*
Fantasy question: What would your dream dog be like? (If this dog is not a fit, we may be able to recommend another based on what you say here.)*
How much do you feel you can reasonably afford and would be willing to spend on your dog per year for things like veterinary care, licensing, ID tag, food, toys, crate, bed, other supplies, training, pet sitting, etc?*
What is your Yearly Pet Budget allocated to Unexpected Serious Injury, Medical Condition or Illness? *
What activity/energy level do you prefer?*

Wild and crazy is coolLeash trained daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potatoOther
Please check all that apply. I want to adopt this dog...*

As a family petTo breed with my dogTo train/use for huntingTo train/use for agilityTo train/use as a therapy dogTo train/use as an assistance dog for the disabledTo use as a guard dogFor a jogging/hiking partnerTo interact with lots of friends/familyAs a gift for a friend, partner, or family memberAs a companion for my dog(s)As a companion for my cat(s)As a companion for my child/childrenOther
Have you ever sold a pet, given a pet away or surrendered a pet to a rescue or shelter ? if yes, What were circumstances? Approximate date?*
Please check all that apply. My adopted dog will...*

Be kept outside most of the timeBe kept indoors most of the timeBe left outside during the work day or while we are awayBe kept inside while we are awayBe crated inside home when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usTake frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenMust be housebroken prior to adoptionI will house train or give refresher lesson if neededWill be walked more than one mile per day every dayWill be walked occasionallyBe attending formal group obedience classes with usBe trained by us without the advice of a trainerHave private sessions with a trainer as neededBe attending agility classes and or participate in agility competitionsBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe given away to someone else if we feel it's not a good match for usBe turned in to a shelter if we can't keep itBe going camping with usBe going on boat trips with usBe outside with a dog house in a fenced areaBe outside chained/tethered to a dog houseBe free roaming on the farm (un-fenced)Ride on golf cart with usOther
Please think and be honest with yourself and with us when answering this question; What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?*

HousebreakingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenMouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training)GrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingCounter surfingBlindnessLimited SightDeafnessSeparation AnxietyDiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineTaking classes with the dogGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin allergiesFood allergiesTrimming nailsYeast on coat or in earsEar mitesFleasTicksHeartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
What would you do in case of any of the above happens?*
What would cause you to return a dog?*
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family?*
How do you plan to introduce & integrate this dog into your family?*
How do you plan to get dog used to your house, yard & neighborhood *
What would you do if you discovered after adoption (at any time during the life of the dog) if your vet diagnosed an expensive health condition?*
What would you do if you discovered after adoption that dog was not completely house-broken, Didn't come when called or had other behavior or training problems (at any time during the life of the dog)? *
Do you have an emergency plan in case YOU are suddenly injured, ill or unable to take care of your pet ?*

YesNoI would like Rescue to send me some information on making emergency preparations for pet.Other
What brand of dog food do you plan to feed?*
Grooming & Care (please check all that apply)*

Don't care about sheddingWe trim dog nails ourselves at homePrefer a dog that doesn't shedWe bathe our dogs at home when neededWe bathe our dogs at home once a monthWe use a professional groomerWe bathe our dog twice a yearWe don't bathe our dogWe check ears weekly for infection/yeast/mitesWe check coat daily for ticks in spring/summer/fallWe clean teeth using home methodsWe take our dogs to the vet for dental cleaning or care whenever the vet recommends this is neededVet or Groomer Clips toenailsWe Clip toenailsI check dog after all walks for ticksI check dog once a week for ticksI check dog every few days for ticksI plan on using an oral flea/tick preventitiveI plan on using a Flea/tick collarI plan on using Topical Flea and TickI give heartworm prevention monthlyI Have Vet test dog for heartworm YearlyI would like rescue to help me understand grooming and care needs of the dog i plan to adoptI am an experienced dog owner and i do not need rescue to help me understand the grooming or care needs of the dog i plan to adopt
How long have you been looking for a dog and what kind of searching or applying have you done?*
What kind of searches have you done i.e. craigslist, visits to shelter etc
Are you planning to take dog to formal group obedience classes?*

YesNoOther
Would you attend obedience if Rescue required it as a condition of adoption??*

YesNo
Have you ever adopted a rescue group or shelter dog before? If yes name of group/shelter, approximate date, groups address/ location.
Additional references (if desired) Give Name, Address, Phone, Relationship, years known.
Please tell us in your own words, why you think you would make the ideal home for the dog you are applying for...
Legal History: Please answer truthfully and note - an affirmative answer to any of these questions will NOT automatically preclude you from adopting an animal.
Have you or your co-applicant ever been served an eviction notice or been asked to vacate a property, whether through foreclosure proceedings or otherwise? (give details)*
Has either applicant, co-applicant or any household resident ever been charged with or convicted of a violent crime against people or animals? If yes, details of charges or conviction , date and what city /state ? Please list details**
How To Hand Sign Form please use trackpad/mouse on your device to sign form. Bring curser to the signature line and scroll / sign as if curser is your pen. Hand signatures resquired here, forms submitted with typed signatures will not be processed.
Applicant's Hand Signature Required (typing your name or leaving blank will nullify application) *

Clear
Use Mouse Arrow and hand movement of mouse to sign form
Co-Applicant's Hand Signature Required (typing your name or leaving this area blank will nullify application) *

Clear
Use Mouse Arrow and hand movement of mouse to sign form
Today's Date
Please Attach a PDF Copy of your CURRENT LEASE if you rent -OR-submit PROOF of HOMEOWNERSHIP via pdf septa bull proof of homeownership would be a copy of current property tax bill, cover page of home insurance policy, city sewer or water bill. PLEASE USE FILE UPLOAD BUTTON ON THIS FORM TO SUBMIT. omission of these documents will nullify your application BUT if you have difficulty submitting your documents here then send us an email & request a snail mail address to send your documents, (this is not recommended as it will slow process)

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IMPORTANT REMINDER: for your application to be considered you Must immediately include the following:

Proof that pets are permitted where you reside. *Use the upload pdf button on this form to send us a PDF copy of your lease/or proof of homeownership. Renters or home occupants without a written lease may send us a letter from housing manager (ask for details).

And Please donate. Your generous donation submitted with your applicaton will help us cover the expense of our online application form service, website designer/hosting/updates and helps enable us to continue to rescue and care of the dogs. Suggested donation $30.(or more if you are able). Please Click link to donate http://PayPal.me/CanineProtectors

Thank you for partnering with us to make a lifesaving difference.
To submit application You 1st must click PREVIEW, then look for red to indicate errors/omissions, if you see the red please make needed Corrections, then choose SUBMIT, (In Preview mode any errors or omissions are outlined in red).

Then you should receive 2 emails: both from “JotForm” A confirmation of submission and then a another with a copy of your application - hold onto that email, we may ask you to forward it to us.

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Remember; We DO NOT adopt first come first serve, because not every match is made in heaven, therefore we accept and consider several applications for each dog to find the best fit, this may take us a while... your patience is greatly appreciated

ADVISEMENT:
We are shorthanded due to Covid, and we’re also dealing with delays due to winter storms, lack of volunteers etc, we are currently estimating 4-8 weeks out to verify your application info, check references & vet history.

Thank you for taking the time to apply to adopt your newest family member from Canine Protection League.

——— 🐕———-

Because our priority is the long-term happiness of the dog and their adoptive family Rescue may pause, stop or decline adoption at any point with or without explanation.

THANK YOU!
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Your privacy is very important to us. In order to assist you Canine Protection League gathers Information from you strictly on a voluntary basis, this information includes but is not limited to your name, address, email, and phone numbers. CPL may collect this and other personal personal information if you fill out a contact form, application, request information from us, make a donation, sign-up to join our eMail list, etc. Except as permitted in this privacy policy, we will never sell, transfer, give, exchange or rent your personal information to any other party or organization without your explicit permission, nor will we send mailings on behalf of other organizations. The only exception on releasing personally identifiable information is if we believe it is necessary and appropriate to comply with applicable laws or regulations, and/or to protect the rights, property, or safety of Canine Protection League Incorporated, the pets we rescue, our volunteers or others. CPL reserves the right to make changes to this privacy policy. If CPL makes a material change to this privacy policy and /or related practices, including how we collect and/or use personally identifiable information, we will indicate this on this form and or our website that our privacy policy or related practices have changed and we will provide a link to our new privacy policy, We encourage each visitor periodically to review this policy to ensure that you will know what personally identifiable information CPL collects, How it may be used, as well as to keep you current as to revisions and/or changes to this policy. Thank you for your support of our mission and interest in adopting from Canine Protection League.
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