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:*

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

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

Area CodePhone Number
Home Phone:

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse/Significant other:

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

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

YesNoOther
Children residing in the home, ages:
Other occupants in the home and relations:
Visitors or service repair people:

HousekeeperService or repairmanPest controlFamily & friendsOther
Where will the dog be kept during these visits:
Have your children been around dogs and animals before?

YesNo
Describe children experience with dog(s) and animal(s):
Are all members of your household in agreement with this adoption:*

YesNoDon'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?*

YesNo
Describe:
Type of dwelling:*

HouseCondoMobileTownhomeApartment
Do you own or rent:*

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

YesNo
Are there any restrictions from your landlord or subdivision:

Number of petsSize or weight restrictionsBreed restrictionsNone
Restriction details:
Landlord's name:

First NameLast Name
Cell Phone:

Area CodePhone Number
Do we have permission to contact your landlord:

YesNo
Details or if not why:
Do you have a fully fenced yard:*

YesNo
Type of fence:*

Chain LinkWoodBlock wallOther
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:*

YesNoOther
Do you have a pool:*

YesNo
Is it fenced separately from the yard:

YesNo
Who has access to your yard:*

GardnerPool cleanerUtility personalNeighborNo oneOther
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:*

YesNoOther
If not, why:
Have you bred a dog or animal:*

YesNo
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):*

YesNo
If yes, what:
Have you adopted from an dog or animal welfare group before:*

YesNo
If yes, what group:
Have you ever given up a dog or pet:*

YesNo
If yes, what were the circumstances:
Do you have a regular veterinarian:*

YesNoOther
Veterinarian:

First NameLast Name
Phone:

Area CodePhone Number
Do we have permission to call your veterinarian:

YesNo
If no, reason:
Hospital:
Address

Street Address

Street Address Line 2

CityState / Province

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

Companion for youCompanion for kidsCompanion for another petGiftWatchdogEmotional supportService dogOther
Details:
Preferred level of exercise and activity with dog:*

Couch PotatoShort walksVigorous walksLong hikesJob regularlyOther
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:*

FamilyFriendNeighborKennelDog sitterOther
Details:
Brand, type of food will you feed:*

Kibble (dry food)CannedHuman grade animal foodMedical, special diet if neededRaw dietTable scrapsHuman foodOther
Details and food brand name(s):
Other type of treats, snacks:
Who will groom and bathe your dog:
Will your dog wear a collar:*

YesNoOther
When and where will they wear collar:
Type of collar:*

LeatherNylonChoke chainHarnessPinchOther
Describe or if other, please explain:
Will your dog wear permanent I.D. tag:*

YesNoOther
Rate your level of guardianship experience:*

First TimeBeginnerIntermediateAdvancedOther
Details:
How will you discipline for misbehavior:
How will you reward for good behavior:
How will you train this dog:*

Professional trainerObedience classHit with newspaperFirm verbal commandsClickerHand signalsOther
Details:
Do you plan to take an obedience class with your dog:*

YesNoNot sure
If yes, who/where:
How often will you walk your dog:*

OftenTwice a weekEvery few weeksRarelyNeverOther
How will you walk your dog:*

On leashOff leashCollar onlyChoke chainHarnessPinch collarOther
Where will you allow your dog off leash:*

WalkingHikingBeachMountainDog parkPublic parkFront yardOther
Can you commit, long term, to care for your dog for its entire life span, which could be 10 - 20 years:*

YesNoOther
Are you planning on moving within the next 5 years:*

YesNo
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:*

YesNoOther
Which of the following reasons may promt you to give up on your dog: (Check all that apply)*

Excessive barkingBitingDiggingMovingDivorcePoor watchdogDestructive chewingFinancial problemsOccasional accidents indoorsGrowling at peopleAggressive on leashExcessive vet billsSheddings, AllergiesNew spouse, a partner doesn't like dogsNew babyNothing 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:*

YesNo
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:*

YesNoOther
Are you willing to use a crate for the health and well-being of the animal:*

YesNoOther
Details:
Is there anyone home during the day:*

YesNoOther
How many hours each day will your new dog be home alone:*
Will the dog be:*

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

Fenced yardEnclosed patioGarageBalconyDog houseUnfenced common areaOther
Doggie door:*

YesNoOther
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:*

YesNoOther
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:*

YesNoOther
How did you find out about our available dogs:*

AdoptaPet.comPetfinder.comFacebookDDM websitePetSmartFriend/Family MemberOther
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 NameLast Name
Relationship:
Cell Phone:

Area CodePhone Number
Reference # 2:

First NameLast Name
Relationship:
Cell Phone:

Area CodePhone 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
Should be Empty:

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information