Summit Dog Rescue Adoption Application

Application for Canine Guardianship

SDR is a very unique dog rescue. A large part of our mission is humane education, and creating a lifelong successful relationship between people and their dogs. We encourage you to read about us AND listen to our podcast(Pod To The Rescue) before applying. Our focus is on careful placements.
Applicant's General Information

**WE DO NOT ADOPT OUT TO PEOPLE UNDER AGE 26 without prior board exception!**
Full Name of Applicant*
Occupation:*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Co-Applicant (Spouse, significant other, roommate):
Personal Email:
Occupation

Please list all pets in your household. Include both current AND past. *

	Species & Breed	Age	Gender	Spay/ Neuter?	Temperament	Residing with you?
1
2
3
4
5
6

For any pet no longer residing with you, please tell us why the pet is no longer in your home:*

Please list all the people in your household. NOTE: SDR DOES NOT regularly PLACE DOGS IN HOMES WITH CHILDREN UNDER AGE 9. You may email and ask for exemption. *

	Name	Age
Self
Person #2
Person #3
Person #4
Person #5

Is everyone in the household on board with adopting a new dog? Please note each person’s level of commitment to the new dog using the following 1-to-5 scale: 0 indicates “don’t want a new dog in the house,” 1 indicates “I will be ok with having a new dog in the house but do not intend to be responsible for his/her care”; 5 indicates “I am excited about adding a new dog to the home and look forward to being responsible for his happiness, training, and wellbeing.”

	1	2	3	4	5
Self
Person #2
Person #3
Person #4
Person #5

Why do you want a dog and why is now a good time to adopt?*
Do you have your heart set on one specific SDR dog? If so, which one? **Tell us what you anticipate in regards to its needs for attention, training and exercise?***** *
Your Environment

Some dogs need a specific environment in order to be successful. More information here will really help us ensure a good fit! Please describe your residence & environment:
What kind of home environment do you have? Rural, suburban, urban? Townhome, house, apartment, duplex, cabin etc? *
Do you own or rent? Is your landlord okay with a dog? *
How long have you resided at this location? *
Do you have a fully fenced yard?*

YesNo
If you have a fenced yard:
General description of fence (size, material, height please):
Does anyone in the home smoke cigarettes?*

YesNo
Do you have any health concerns or condition that affects the kind of dog that would be a good fit, or may do so in the future? If yes, please describe (i.e. asthma, allergies, Lyme disease, upcoming surgeries, arthritis)*
What type of human companionship will your pet have during the day? How many hours would he/she be left alone and, when home alone, where will the pet be?:*
: Where will your dog sleep at night? *

Questions Regarding Vet Care
What do you think would be reasonable to spend on medical care? What do you consider to be part of those expenses?*
What brand of dog food will you feed your dog? Why this brand?*
Have you ever had a dog with a medical emergency (i.e., torn ACL or bloat) or a long term illness (i.e. cancer)? Please explain: how did you treat the condition; what was the cost; what was the outcome? *
Behavior

****The first few months upon adopting tend to be the most difficult. Your new dog has been through many transitions, and your home is just one more transition . New behaviors can crop up, or previously seen behaviors can be amplified during the transition period. Working through these issues can be challenging and time consuming, and so please be as clear and honest as possible so we can help you get as close to the right fit as possible. Make sure all household members are on board with your answers!!! Please note that dogs have the emotional capacity of a 3-4 year old child.***

The full Summit Dog adoption process includes a Zoom interview, a personal reference check, and then a meet and greet! There is never a guarantee that an adoption will occur, until the adoption paperwork is signed. Submission of this application confirms that you understand and agree to the need for screening of adopters, and certify that the information supplied on this application is true and correct. The terms “guardian” and “owner” shall be considered interchangeable. Please initial here that all your responses are truthful and complete.*
If you are accepted to adopt a dog from SDR, we will ask you for personal references and a vet reference if you have one.
Should be Empty:

Now create your own Jotform - It's free!Create your own Jotform

Application for Canine Guardianship

Applicant's General Information

Your Environment

If you have a fenced yard:

Questions Regarding Vet Care

Behavior

Please read the below article to answer the questions below:

Almost done!

If you are accepted to adopt a dog from SDR, we will ask you for personal references and a vet reference if you have one.