Sherry Saving Discarded Dogs Adoption Application

Today's Date*

MonthDayYearHourMinutesAM/PM Option

Pet's Name (if known)*

Litter Name*

Contact Information

Applicant Full Name*

First NameLast Name

Phone/Cell Number*

Address*

Street Address

Street Address Line 2

CityState

Zip Code

County*

How long at this address*

Place of employment*

Occupation*

How long?*

E-mail*

Check any and all that apply for applicant:

Under age 25Over age 65

Have you applied with Sherry Thomas SSDD before?*

Yes and I adopted!Yes but didn't adopt.No

Who and when did you adopt?

Dog's name & date adopted

When did you apply?

Date

Co-Applicant / Back-Up Caregiver (someone other than yourself, in the event you are not able to care for the dog) Must be 18 years old.*

First NameLast Name

Relationship to Applicant:*

Phone/Cell Number*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

How long at this address?*

Place of employment*

Occupation*

How long at this place of employment?*

E-mail*

Family & Housing

How many adults are in the household?*

What is their relationship to you?*

How many children in the household?*

What are the ages of the children?

What type of home do you live in?*

Name of Apartment Complex, Mobile Home Park or Sub Division.*

Please describe your household.*

How much do you think routine vet care costs yearly?*

What is your reason for adopting?*

Have you had Parvovirus at your home within the last 12 months?*

NoYes

If yes, please give date:

Your Current Pets

Do you have other pet(s) that you own and/or have living with you?*

YesNo

Pet #1 - (specify type, breed, sex, weight, temperament, name and age)

Pet #2 - (specify type, breed, sex, weight, temperament, name and age)

Pet #3 - (specify type, breed, sex, weight, temperament, name and age)

Pet #4 - (specify type, breed, sex, weight, temperament, name and age)

Are these pets up to date on vaccines?

YesNo

Are your dogs on heartworm preventive?

YesNo

Are these pets spayed/neutered? If not, why.

Have you ever surrendered a pet or re-homed a pet? If so why & when.*

Have you ever had a pet euthanized? If so, why & when.*

Have you ever lost a pet to an accident? When. If so, explain.*

How do you discipline your pets (or how will you discipline your new pet)?*

Veterinarian

Do you have a regular veterinarian?*

YesNo

Veterinarian's Name*

First NameLast Name

Veterinarian's Phone Number*

Area CodePhone Number

Clinic Name & Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

About the Dog You Wish to Adopt

Desired Age:*

Desired sex:*

Desired size, when full grown:*

Desired breed(s):*

Breed(s) you would not adopt:*

Average # of hours pet will spend alone daily*

Where will the dog spend the day? Be specific.*

Where will the dog spend the night? Be specific.*

Who will have primary responsibility for this pet's daily care?*

Who will have financial responsibility?*

Do you agree to provide regular health care by a Licensed Veterinarian?*

YesNo

Do you agree to keep the dog on monthly heartworm protection?*

YesNo

Do you agree to have the dog Micro Chipped?*

YesNo

Do you agree to a follow up phone call regarding the adoption/pet?*

YesNo

Do you agree to keep the dog as an indoor pet? If no, explain why not.*

How do you plan on supervising the pet while outside?*

If you have a fence, what type.*

DO YOU AGREE TO CONTACT SSDD IF YOU CAN NO LONGER KEEP THIS DOG OR CARE FOR ITS HEALTH NEEDS? (she will help you, help your dog)*

YesNo

I understand that I must contact SSDD if I can no longer keep this pet I have adopted.*

Type your initials here

DO YOU AGREE THAT THIS PET MAY ONLY BE RE-HOMED WITH FAMILY, A FRIEND, A NEIGHBOR, OR CO-WORKER, SOMEONE YOU TRUST ONLY? ( SSDD must be notified of this)*

YesNo

I understand that I must notify SSDD if I intend to re-home the pet I adopt.*

Type your initials here

Are you willing to let a representative of SSDD visit your home by appointment before and after adoption?*

YesNo

How much are you prepared to pay for emergency vet care?*

What energy/activity level of a dog would you like?*

How do you plan on exercising your new dog?*

Will you commit to a training class, if needed?*

YesNo

Are you prepared to care for this dog for up to 15 years?*

YesNo

I understand that I am adopting a rescue dog. SSDD can only estimate the dog's age, breed, and adult weight.*

Type your initials here

Personal References

Please list someone who is familar with you, your home, and your pet(s) that does not live in your home and that is not a relative. Must be different than Back up Caregiver or Co-Applicant at beginning of application.

1. Reference Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Phone Number*

Area CodePhone Number

Relationship (neighbor):*

2. Reference Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

County*

Phone Number*

Area CodePhone Number

Relationship (friend or co-worker):*

Landlord/Property Manager

Do you own, rent or live with parents?*

OwnRentLive with Parents

If you live with parents, do your parents own or rent?

OwnRent

If you rent or live with parents, please give the property owner's name and number and the rules governing pets:

Landlord/Property Manager or Parents Name:

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Rules Governing Pets (specifically breed & weight restrictions):

Please Read the Following and Sign Below

Providing SSDD with this information means you are allowing a SSDD Representative to call your vet, property owner, and references during the application process. You also agree that SSDD may follow up with said contacts after adoption has taken place. Please understand our goal is to make sure these animals are placed in good homes. The responsibility of SSDD is the best interest of the animals. SSDD has the right to refuse an adoption for any reason. The application remains the property of SSDD.

I certify that the above information in this application is true and accurate to the best of my knowledge. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that Sherry Thomas SSDD reserves the right to annul the adoption and reclaim the animal.

The adopted animal will reside in my home as a pet. I will provide it with quality food, plenty of fresh water, indoor shelter, affection, annual physical examination, monthly heartworm prevention and yearly vaccination under the supervision of a licensed veterinarian. I agree that "chaining" or "tethering" this animal is prohibited. If a rehoming needs to occur, I will contact SSDD for help and advice. If at a later date I am unable to care for this animal, I agree to contact SSDD described above and give them the option to reclaim this animal at no charge before I attempt to rehome this animal myself.

Once you submit your application, we should receive it within 24 hours. You will be notified that it has been received and has moved onto the review process.

Our application review process can take several days. The quicker you respond to any requests we may make for additional information, the quicker we can process your application.

If we are asking for additional information, it doesn't mean that you are the individual approved to adopt the dog, we are still reviewing your application. Please be aware that a single dog or puppy can receive multiple applications.

If we think your family would be a good fit for that dog/puppy, we will invite you to schedule a meet and greet appointment.

Following your meet and greet we will then decide whether you will be the dog/puppy's chosen adopter and notify you. Please allow some additional time following the meet and greet to make a decision.

Applicant Signature*

First NameLast Name

Date*

MonthDayYear

Applicant Signature*

Co-Applicant or Back-Up Caregiver Signature*

First NameLast Name

Date*

MonthDayYear

Co-Applicant Signature*

Sherry Saving Discarded Dogs SSDD

Dog Adoption Application Form

Contact Information

Family & Housing

Your Current Pets

Veterinarian

About the Dog You Wish to Adopt

Personal References

Landlord/Property Manager

Please Read the Following and Sign Below