CARE Dog Adoption Application

Dog Adoption Application

Rev. 5/11/2023
Dear applicant:

Thank you for your interest in adopting from us! We are an all volunteer, no-kill, 501C3 animal rescue/shelter servicing the Southcoast Region of Massachusetts. We focus our efforts on older animals, sick animals, animals with behavioral issues that would not make it in a traditional shelter, but will take in any animal requiring assistance. Our mission is to place all of our animals in loving, permanent homes.

The adoption fee is $600.00 for puppies and young dogs under 2 years, $500.00 for 2-7 years, $375.00 for seniors 7 years and older. The adoption fee is subject to change based on the cost of care that went into preparing the dog for adoption.
General Information
WLast Name
Age of Applicant*
Applicants must be at least 21 years old to adopt
Name of Co-Applicant

First NameLast Name
Email Address*
Cell Number*

Area CodePhone Number
Alternative Phone Number

Area CodePhone Number
Employment*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What type of dog are you interested in adopting? Check all that apply.*

PuppyAdultSeniorUndecided / no age preference
Are you interested in adopting a specific dog?*

Yes - I am applying for a dog I saw on PetfinderYes - I am applying for a dog I met in foster careYes - I am applying for a dog that I saw on FacebookNo - I am still considering all options that might be a good fit
Which dog(s) are you interested in adopting?*
List the name(s) of all dogs you're interested in
Describe the type of personality and/or appearance you would like your dog to have:*
Ex: playful, friendly, good with kids, good with other dogs, male etc.
If the dog(s) you are interested are no longer available for adoption, would you like us to continue to process your application for pre-approval in the event that another dog that interests you?*

YesNo
Who is this pet for?*

MyselfMy familyRelativeFriendOther
Are all members of the household aware of the adoption and in agreement?*

YesNo
Have you applied to adopt from CARE Southcoast previously?*

YesNo
Have you adopted from CARE Southcoast previously?*

YesNo
Are you looking to adopt now, or in the future? *
If future, please provide an estimate as to when you'll be ready to bring home your new dog
Home & Family
Describe your home*

Single-FamilyApartmentCondo/DuplexPublic HousingStudent Housing
Do you own or rent your home?*

OwnRentI live with a parent, guardian or family member
If you rent or live in a family member's home, please provide their contact information here:
Ex: Landlord - Becky Allen (111-111-1111)
Who else lives in the home or visits regularly? Please list names and ages for individuals under 18 years of age.*
Ex: Michael, husband (41); Jessica, daughter (7). Susan, mother-in-law (80).
Is your home busy or quiet?*

BusyQuietA mix of both, depending on the time & day
Are any members of the household allergic to pets (eg. dogs, cats etc.)*

YesNo
If you had to move, are you willing to find housing that accepts pets?*

YesNoMaybe
Does your home have a yard?*

Yes - front & backYes - just front/backNo
Is your yard fenced?*

YesNo
How do you plan to exercise your dog and allow it to relieve itself?*
Provide detail
Current & Past Pets
Do you have any pets currently?*

YesNo

Have you had any pets of your own in the past 10 years?*

YesNo - this is my first pet

Have you ever had a pet euthanized?*

YesNo
If yes, please explain the circumstances:
Are you willing/able to take your pets to yearly check-ups?*

YesNo
If your pet becomes ill, are you able to afford a veterinary bill?*

YesNo
How many hours per day would the dog be alone?*
Do you plan to crate train your dog?*

YesNoIt depends/I am undecided
Where will your dog live primarily?*

IndoorsOutdoorsBoth indoor & outdoors
If your dog will be kept indoors & outdoors, please provide more detail on when you'd keep them indoors vs. outdoors:*
Ex. Would it be seasonally? Do you have a dog house or outdoor shelter? Would they be chained up?
How many times do you plan to walk your dog each day?*
How would you deal with behavioral issues such as excessive barking, destructive behavior, inappropriate urination etc.?*
Does your home have space (i.e. a spare bedroom, office, or bathroom) to separate new pets from current pets during the acclimation and introduction period?*

YesNo
Are you willing to give your dog time to adjust to its new environment? (Note: this could take anywhere from several days to several months)*

YesNo
If you have to leave town, urgently or planned, where would your dog stay or who would take care of it?*
If you were no longer able to care for your dog, or had to move, what would happen to your dog?*
Have you ever had to re-home a pet or surrender it to an animal shelter, animal control etc.?*

YesNo
If you answered "Yes" to the above question, please explain the circumstances:
Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

YesNo
If you answered "Yes" please provide a detailed description:
Are you willing and able to care for your dog for the full duration of its life (10-15+ years)?*

YesNo
Veterinarian

Please list your current / previous / planned veterinarian(s) and their phone number(s). CARE will contact them to verify your current pets are up to date on shots, fixed and tested; this is a requirement for new pet adoptions. Please call their office(s) to authorize release of information to CARE. If you are planning to utilize another vet but are not currently a client, please note that information.
Vet Clinic*
Vet Clinic*

Area CodePhone Number
Last name that the pet(s) are listed under (if applicable):*
Previous Vet Clinic
Previous Vet Clinic

Area CodePhone Number
Personal References

Please provide 2 non-family references (eg. neighbors, coworkers, family friends etc.)
Reference 1*

First NameLast Name
Reference 1*

Area CodePhone Number
Relationship to Reference 1*
Ex. Neighbor, coworker, roommate, family friend
Reference 2*

First NameLast Name
Reference 2*

Area CodePhone Number
Relationship to Reference 2*
Ex. Neighbor, coworker, roommate, family friend
Terms & Conditions
I certify that I am at least 21 years of age*

AgreeDisagree
The information I have provided on this application is true. I also recognize that any misrepresentation or omissions may result in the loss of privilege to adopt from CARE*

AgreeDisagree
I understand that CARE has the right to deny any application for any reason*

AgreeDisagree
I understand that CARE is not able to guarantee the health or temperament of any dog, as many dogs come in with unknown histories. There are traits that could change upon adoptions and I take responsibility to care for and address these issues if they do arise*

AgreeDisagree
I understand that anything could happen in life, and if I find that I am no longer able to care for my adopted dog, I agree to contact CARE by phone and/or email to discuss return/or need for help of the adopted animal*

AgreeDisagree
I understand that I am to immediately contact CARE in the event that my adopted dog is lost/missing*

AgreeDisagree
I attest that the dog I am adopting is for me, in my home, and NOT a gift for anyone*

AgreeDisagree
I understand that I am responsible for paying for all follow-up vaccines, wellness visits & medical procedures my pet will require in the future.*

AgreeDisagree
I hereby authorize CARE Southcoast to contact my references, veterinarian(s), and landlord to verify said statements.
Signature of Applicant*

First NameLast Name
Date*

MonthDayYear
Date
Heading
Should be Empty:

	Name	Type of Animal	Sex (M/F)	Age	Fixed? (Y/N)	Up-to-date on vaccines? (Y/N)
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5

	Name	Type of Animal	Sex (M/F)	Age	Why don't you have them any longer?
Pet 1
Pet 2
Pet 3
Pet 4

Dog Adoption Application

General Information

Home & Family

Current & Past Pets

Veterinarian

Personal References

Terms & Conditions

Heading