A New Day Animal Rescue Adoption Application

Dog of Interest:

Date:

Date

In order to be considered as an adopter you must:

Be 21 years of age or older
Have identification showing your present address
Have the knowledge and consent of your landlord
Be able and willing to provide a loving, safe and peaceful environment for this pet
Be financially stable and currently employed
Be willing to provide any and all necessary medical care throughout the pet's life

Pet ownership is a serious responsibility. The policy of this adoption group is to ensure that each person who adopts a pet is aware of the responsibility and is capable and willing to accept that responsibility morally, physically and financially. The following questionnaire has been designed to aid both you and the adoption group in deciding if you and/or your family are adequately prepared to assume the responsibility of pet ownership.

Please be sure to ANSWER ALL QUESTIONS and feel free to add your own comments.

If a question does not apply write N/A.

Name:

Date of Birth:

Date

Driver's License Number:

Phone Number:

Email Address:

example@example.com

What is the best way to contact you?

Address:

Address

Street Address Line 2

City

Zip

Occupation:

Employer Name & Phone Number:

Spouse's Occupation:

Spouse Employer Name & Phone Number:

Please list the name, age and relationship to yourself of each person currently living in your house.

Does anyone living in your home have any known pet-related allergies?

Do you rent or own?

Length of time at current residence?

Do you plan to move within the next 6-12 months?

If you rent, are pets allowed?

If you rent, is there a pet deposit?

What is the name and contact info for the property owner/ agent?

Why do you want to adopt at this time?

Do all adults in your household know you plan to adopt?

Have your children ever been around dogs and/or cats?

Has anyone in your household ever been bitten by a dog?

Do your current pets get along with other animals?

Where will your new pet sleep at night?

In what areas of the house will the dog be allowed?

Approximately how many hours a day will the dog be home alone?

Do you have a fenced yard? (This is not a requirement.)

Do you have any balconies? A Pool? A Dog door?

Where will your pets stay if and when you travel?

PAST/PRESENT PET HISTORY: Please list the name, type, age, gender, and if pet is spayed or neutered of all current animals and past pets. (Ex: Duke, yellow lab, 1 1/2 years old, male neutered) For past pets, please explain why you no longer have that pet (Ex: Died of old age, Rehomed, etc.)

Are current pets up to date on vaccinations? Please give approximate date of last vaccines/vet visit.

Name of current or last veterinarian? Name/phone number?

Which of the following situations would lead you to give away your pet? Ruins the furniture, children will no longer care for dog, grooming or vet care is too expensive, allergies, getting married or divorced, birth of a child, other (explain).

What would you do with your pet if you could not keep it for the reasons stated above?

Have you ever surrendered a pet to a shelter/pound? If yes, why?

PLEASE PROVIDE TWO PERSONAL REFERENCES:

NAME:

PHONE NUMBER

EMAIL:

example@example.com

NAME:

PHONE NUMBER

EMAIL:

example@example.com

How did you hear about us?

Is there anything else you would like to tell us that you think would be important when considering your application?

Please read and sign below: Many factors determine which applicant will be matched with a particular dog. If you are not able to adopt a dog today, it does not mean that you are not considered a good dog owner or that your home is not acceptable. Our goal is to place all dogs into homes that will best suit them.

Please ask for clarification if you have any questions.

I have completed this application truthfully and fully understand the adoption process.

E-Signature (type name):

Date:

Date

If we do not call or email you within 7 days of receiving your application, it means that either:

1. The dog was adopted by a previous applicant.

2. We felt the situation presented on the application was not the right situation for that dog.