DDM Adoption Application

Pet Adoption Application

Dharma Dog Movement is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected, and abused animals. Dharma Dog Movement is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering, and microchipping prior to their adoption.

This questionnaire is designed to help Dharma Dog Movement determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Dharma Dog Movement reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions.
Applicant Information
Date: *

Month Day Year
Date
Name of the dog(s) you are interested in: *
Tell us why you are interested in this particular dog(s):
Applicant name: *

First Name Last Name
Occupation: *
Email:
example@example.com
Cell Phone: *

Area Code Phone Number
Home Phone:

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Spouse/Significant other:

First Name Last Name
Occupation:
Email
example@example.com
Cell Phone:

Area Code Phone Number
Household Information
Are there children and other occupants living in the home or have extended visits: *

Yes No
Children residing in the home, ages:
Other occupants in the home and relations:
Visitors or service repair people:

Housekeeper Service or repairman Pest control Family & friends
Where will the dog be kept during these visits:
Have your children been around dogs and animals before?

Yes No
Describe children experience with dog(s) and animal(s):
Are all members of your household in agreement with this adoption: *

Yes No Don't Know
If not, why:
Who will be the pet's primary caregiver: *
Does anyone in your home have allergies to dogs or have asthma? *

Yes No
Describe:
Type of dwelling: *

House Condo Mobile Townhome Apartment
Do you own or rent: *

Own Rent Rent agreement to own
Does your landlord allow dog(s):

Yes No
Are there any restrictions from your landlord or subdivision:

Number of pets Size or weight restrictions Breed restrictions None
Restriction details:
Landlord's name:

First Name Last Name
Cell Phone:

Area Code Phone Number
Do we have permission to contact your landlord:

Yes No
Details or if not why:
Do you have a fully fenced yard: *

Yes No
Type of fence: *

Chain Link Wood Block wall
Fence measured highest and lowest point: *
Describe the bottom where the fence meets the ground: *
Describe the condition of the fence: *
I promised to inspect my fence thoroughly before the home visit and make necessary repairs for the safety and well-being of our new companion.
How many gates & how high: *
Type of lock(s): *
If no locks, are you willing to install prior to placement should this application be accepted: *

Yes No
Do you have a pool: *

Yes No
Is it fenced separately from the yard:

Yes No
Who has access to your yard: *

Gardner Pool cleaner Utility personal Neighbor No one
Where will the dog be located during these visit(s):
How will you introduce the dog to visitor(s):
Are there wild animals located near your home: (Snakes, Coyotes, Bird of Prey, Mountain Lions, Bears: *
Current/Previous Pet Information
Dogs & animals living in home, type, breed, gender, age: *
Are all animal(s) spayed/neutered: *

Yes No
If not, why:
Have you bred a dog or animal: *

Yes No
If yes, why:
List dogs and animals you have been a guardian of since you have been an adult, length of time and what happened to them: *
Do you have live stock or farm animals (nearby): *

Yes No
If yes, what:
Have you adopted from an dog or animal welfare group before: *

Yes No
If yes, what group:
Have you ever given up a dog or pet: *

Yes No
If yes, what were the circumstances:
Do you have a regular veterinarian: *

Yes No
Veterinarian:

First Name Last Name
Phone:

Area Code Phone Number
Do we have permission to call your veterinarian:

Yes No
If no, reason:
Hospital:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
New Pet Information
What is the primary reason for a new family dog: *

Companion for you Companion for kids Companion for another pet Gift Watchdog Emotional support Service dog
Details:
Preferred level of exercise and activity with dog: *

Couch Potato Short walks Vigorous walks Long hikes Job regularly
Details:
What type of personality do you want your pet to have: (i.e. calm, energetic, protective)
Who will care for the dog when you are on vacation, business trips: *

Family Friend Neighbor Kennel Dog sitter
Details:
Brand, type of food will you feed: *

Kibble (dry food) Canned Human grade animal food Medical, special diet if needed Raw diet Table scraps Human food
Details and food brand name(s):
Other type of treats, snacks:
Who will groom and bathe your dog:
Will your dog wear a collar: *

Yes No
When and where will they wear collar:
Type of collar: *

Leather Nylon Choke chain Harness Pinch
Describe or if other, please explain:
Will your dog wear permanent I.D. tag: *

Yes No
Rate your level of guardianship experience: *

First Time Beginner Intermediate Advanced
Details:
How will you discipline for misbehavior:
How will you reward for good behavior:
How will you train this dog: *

Professional trainer Obedience class Hit with newspaper Firm verbal commands Clicker Hand signals
Details:
Do you plan to take an obedience class with your dog: *

Yes No Not sure
If yes, who/where:
How often will you walk your dog: *

Often Twice a week Every few weeks Rarely Never
How will you walk your dog: *

On leash Off leash Collar only Choke chain Harness Pinch collar
Where will you allow your dog off leash: *

Walking Hiking Beach Mountain Dog park Public park Front yard
Can you commit, long term, to care for your dog for its entire life span, which could be 10 - 20 years: *

Yes No
Are you planning on moving within the next 5 years: *

Yes No
What would happen to the dog if you moved: *
Out of state:
Out of the country:
Dogs and pets are an investment of your time and money. Do you understand that a dog is a lifetime commitment, and medical care can cost $300 - $500 per year for veterinary care additional to daily care: *

Yes No
Which of the following reasons may promt you to give up on your dog: (Check all that apply) *

Excessive barking Biting Digging Moving Divorce Poor watchdog Destructive chewing Financial problems Occasional accidents indoors Growling at people Aggressive on leash Excessive vet bills Sheddings, Allergies New spouse, a partner doesn't like dogs New baby Nothing and would do everything possible to keep for their natural life
How would you handle these above misbehavior(s): *
Under what circumstances would you not be able to keep this dog: *
Have you ever house-broken a dog or puppy before: *

Yes No
If the dog has an "accident" in your home, what type of correction do you plan to use: *
Have you trained and used a crate before: *

Yes No
Are you willing to use a crate for the health and well-being of the animal: *

Yes No
Details:
Is there anyone home during the day: *

Yes No
How many hours each day will your new dog be home alone: *
Will the dog be: *

Indoor pet: Outdoor Pet:
Where will the dog stay when home alone: Specifics: run of house, specific room, crate, doggy door, i.e.: *
What areas of the house will the dog be allowed: *
What areas of the house will the dog *NOT* be allowed: *
Where will your dog sleep at night: *

Indoor pet: Outdoor Pet:
Details:
What outside areas are available to the dog: *

Fenced yard Enclosed patio Garage Balcony Dog house Unfenced common area
Doggie door: *

Yes No
Details:
A new environment can be stressful for your dog and may need time. Are you willing to work through your new pet's issues, if any: *

Yes No
What length of time will you allow your new dog to adjust to his new home:
Do you have homeowners or rental insurance for the type of dog breed you are applying to adopting from DDM: *

Yes No
How did you find out about our available dogs: *

AdoptaPet.com Petfinder.com Facebook DDM website PetSmart Friend/Family Member
Please read and acknowledge: *

I understand that a home visit is required before placement, but does not guarantee placement. I CAN donate an adoption fee to help rescue, provide medical care, spay or neuter and board. I understand that any donation or contribution is a gift freely given, not a purchase price for a dog. Or, I CANNOT make a minimum donation to help rescue. I understand that I assume full responsibility for the welfare of this pet from the date of adoption. Dharma Dog Movement will stay as the dog's primary contact with the microchip registration company.
The inability to donate does not disqualify an applicant from consideration.
Please offer any other information for adoption consideration:
Reference # 1:

First Name Last Name
Relationship:
Cell Phone:

Area Code Phone Number
Reference # 2:

First Name Last Name
Relationship:
Cell Phone:

Area Code Phone Number
Applicant's Signature:

Clear
Spouse or significant partner's Signature:

Clear
Dharma Dog Movement reserves the right to refuse adoption to any applicant for any reason. This questionnaire will become part of our adoption contract upon approval.
Thank you for adopting and saving a life
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Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information