AdoptionForm

Name of pet interested in:

How did you hear about Our Northern Promise

Full Name - Applicant 1*

First NameLast Name

Age*

Email - Applicant 1*

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular*

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Full Name - Applicant 2

First NameLast Name

Email - Applicant 2

example@example.com

Phone Number - Cell

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityProvince

Postal Code

1st Applicant Employer:

Work Environment:

Years:

Job Title:

2nd Applicant Employer:

Work Environment:

Years:

Job Title:

Do you:

OwnRentLive with ParentsOther

Do you live in a:

If Renting: Please indicate landlord contact information

Home size (sq ft)

How many years have you lived there

Household Setting

RuralSuburbanUrban

Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Yard size (sq ft)

Do you have a fully enclosed fence?

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

How will you secure the pet if there is no fence?

Are there any gaps/openings where a dog can escape?

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?

YesNoOther

Does anyone in your household smoke cigarettes?

YesNoOther

If yes, please select the areas in or surrounding your household in which you smoke cigarettes:

OutdoorsInside the homeIn your vehicleOther

Will the animal have limited access in the house?

Is someone home during the day?

Where will the animal be kept during the day?

Where will the animal be kept during the night?

What is the longest time you think the animal will be alone without a break?

Do you or will you hire a dog walker?

How often do you go on holidays?

Where would the animal stay during the holidays?

Describe your plans for training:

Go to Obedience class?

YesNoOther

Name of Dog Trainer you would use:

Activities you would do with the animal:

Primary Caregiver:

Dog Food Type/Brand:

Who would care for the animal during your illness/death?

How many years do you plan to keep the animal?

Under what circumstances would you give the animal up?

Behaviours that would make you give up the animal:

Do you have a preference in gender of the animal?

MaleFemaleNo Preference

Are you willing to adopt a dog of any age?

YesNo

If not, what age would you consider?

Preferred Breed(s):

Have you owned this breed before?

Preferred Activity Level:

Prepared to groom regularly?

Preferred Attributes:

We cannot guarantee a dog to be fully housebroken, are you equipped to train with love and patience?

YesNo

Are you willing to use a crate for a dog if recommended?

YesNoOther

Please List any Pets you have Living or Deceased (Please include Name, Breed, Age, Altered, Sexe, Living/Deceased)*

Are their vaccinations up to date? If not please explain:

YesNoOther

Please give a brief description of pets owned in the last 10 years (if deceased, cause of death? If surrendered, reason why?)

Where do your current/past pets come from:

What type of heartworm medication do you use?

If not, why?

Who much money would you be willing to spend on vetting per pet?

Will you get pet insurance?

YesNoOther

Is there anything you would like to tell us about yourself?

Please list 3 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?

YesNo

Vet Reference*

Veterinarian NameClinic Name

Address

Street Address

Street Address Line 2

CityProvince

Postal Code

Phone Number

Area CodePhone Number

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Phone Number

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Phone Number

Area CodePhone Number

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

Phone Number

Area CodePhone Number

Understands I am not guaranteed to be approved for animal adoption/selection*

YesNo

Understands it is not first come first served*

YesNo

Willing to select different dog if first is not available*

YesNo

Understands there may be medical issues*

YesNo

Understands there may be behavioural issues*

YesNo

Applicants have checked distance and are willing to travel*

YesNo

Applicants have contacted vet and references to release info*

YesNo

Have you applied for a pet before in the last year*

YesNo

Willing to work with Our Northern Promises to correct problems*

YesNo

Do you agree to pay the fixed donation amount for this pet if approved*

YesNo

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any Our Northern Promise Animal Rescue pet adopted to me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless Our Northern Promise Animal Rescue and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the pet.

I accept full responsibility for the pet(s) actions at all times, and release Our Northern Promise Animal Rescue from any liabilities or damages that may be incurred because of adopting such pet(s).

I agree to have Our Northern Promise Animal Rescue complete reference call checks and conduct a phone screen and home visit inspection to be able to process my adoption application.

I agree that if I'm unable to care for the adopted pet(s) anymore that I will return the pet(s) to Our Northern Promise Animal Rescue.

Date

MonthDayYear

Your name*

Signature

E-mail

Adoption Application

Contact Info

Employment Info

Home Info

Lifestyle Information

Pet Preferences

Current Pet Information

Conditions