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.

Date:

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

Are there children and other occupants living in the home or have extended visits:

Other

Children residing in the home, ages:

Other occupants in the home and relations:

Visitors or service repair people:

Where will the dog be kept during these visits:

Have your children been around dogs and animals before?

Describe children experience with dog(s) and animal(s):

Are all members of your household in agreement with this adoption:

If not, why:

Who will be the pet's primary caregiver:

Does anyone in your home have allergies to dogs or have asthma?

Describe:

Type of dwelling:

Do you own or rent:

Does your landlord allow dog(s):

Are there any restrictions from your landlord or subdivision:

Restriction details:

Landlord's name:

First NameLast Name

Cell Phone:

Area CodePhone Number

Do we have permission to contact your landlord:

Details or if not why:

Do you have a fully fenced yard:

Type of fence:

Other

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:

Other

Do you have a pool:

Is it fenced separately from the yard:

Who has access to your yard:

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:

Dogs & animals living in home, type, breed, gender, age:

Are all animal(s) spayed/neutered:

Other

If not, why:

Have you bred a dog or animal:

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):

If yes, what:

Have you adopted from an dog or animal welfare group before:

If yes, what group:

Have you ever given up a dog or pet:

If yes, what were the circumstances:

Do you have a regular veterinarian:

Other

Veterinarian:

First NameLast Name

Phone:

Area CodePhone Number

Do we have permission to call your veterinarian:

If no, reason:

Hospital:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What is the primary reason for a new family dog:

Details:

Preferred level of exercise and activity with dog:

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:

Details:

Brand, type of food will you feed:

Details and food brand name(s):

Other type of treats, snacks:

Who will groom and bathe your dog:

Will your dog wear a collar:

Other

When and where will they wear collar:

Type of collar:

Describe or if other, please explain:

Will your dog wear permanent I.D. tag:

Other

Rate your level of guardianship experience:

Details:

How will you discipline for misbehavior:

How will you reward for good behavior:

How will you train this dog:

Details:

Do you plan to take an obedience class with your dog:

If yes, who/where:

How often will you walk your dog:

How will you walk your dog:

Where will you allow your dog off leash:

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

Other

Are you planning on moving within the next 5 years:

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:

Other

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

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:

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:

Other

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

Other

Details:

Is there anyone home during the day:

Other

How many hours each day will your new dog be home alone:

Will the dog be:

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:

Other

Details:

What outside areas are available to the dog:

Doggie door:

Other

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:

Other

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:

Other

How did you find out about our available dogs:

Please read and acknowledge:

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:

Spouse or significant partner's Signature:

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

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information