TAPS Pet Adoption Application

We request the following information so that we can assist you in the selection of a new dog. This form and a consultation with a representative of The Animal Protectorates™ TAPS are designed to help you find the dog most compatible with your lifestyle.

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 (if applicable)
* Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care of the dog

The steps to adopt:

Adoption Process

The Animal Protectorates reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions. COMPLETION OF THIS APPLICATION DOES NOT GUARANTEE ADOPTION OF A DOG.

Name*

First NameLast Name

Name of the dog you are interested in:*

This pet will be for:*

MeFamily PetGiftOther

Who will be the pet's primary caregiver?*

Your age:*

Occupation:*

Employer:*

Your Cell Phone:*

Area CodePhone Number

Home Phone:

Area CodePhone Number

E-mail:*

Confirm E-mail:*

Do you have a spouse or significant other?*

YesNo

Spouse or significant other full name:*

Spouse Cell Phone:*

Area CodePhone Number

Occupation:*

Employer:

Work Phone:

Area CodePhone Number

Street Address:*

City, State, Zip:*

Do you have a mailing address that is different than your home address?*

YesNo

Street Address:

City, State, Zip:

1st Personal reference name and phone number:*

2nd Personal reference name and phone number:

Do you live in a:*

Do you own or rent your home?*

OwnRentLive with parents/other famiy

Does your landlord allow dogs?

YesNo

May we contact the owner to obtain permission for this dog to live in your home?

YesNo

Are there any restrictions from your landlord or subdivision?

Number of petsSize or weight restrictionsBreed restrictionsNone

Landlord's name and phone number:

How many adults are in your household?*

How many children are in your household?*

If children, what are their ages?

Have your children been around animals before?

YesNo

Are all members of your household in agreement with this adoption?*

YesNoDon't Know

Do you or anyone else in your household smoke?*

YesNo

Where do you/they smoke?

Do you have a fully fenced yard?*

YesNo

Height and type of fence:

Please explain the reason for no fenced yard:

Do you have any of the following?*

Underground fenceOutdoor KennelDog RunOther

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

YesNo

Have you owned any pets in the past 5 years?*

YesNo

List the types of pet(s) and ages (if still living):

How many of these pets are/were spayed/neutered?

Where are these animals now?

If you currently have pets how will they adjust to a new dog?

Please provide the name and phone number of your current and/or previous veterinarian or clinic and how long you have been a client:

Have you adopted from an animal welfare group before?*

YesNo

If yes, what group?

Have you ever sold or given up a pet?*

YesNo

If yes, what were the circumstances?

Have you ever had a pet euthanized?*

YesNo

If yes, what were the circumstances?

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*

Are you aware of crate training?*

YesNo

Have you ever house-broken a dog or puppy before?*

YesNo

If the dog has an "accident" in your home, what type of correction do you plan to use?*

How many hours each day will your new pet be home alone?*

What percentage of time will this pet be allowed outside each day(%)?*

Do you have a dog door?*

YesNo

Do you have a pool?*

YesNo

Is there a fence around the pool?

Do you have a balcony?*

YesNo

Is your balcony pet proofed?

YesNo

Do you have unscreened windows?*

YesNoI don't knowOther

Do any of the following have regular and/or unsupervised access to your home? (check all that apply)*

Please explain why you are comfortable with this and how you would prevent a pet from accidentally getting out:

The pet will be secured outside using (check all that apply):*

Are there times when the dog will be tied up?*

YesNo

Under what circumstance(s) will the dog be tied up?

Are there stairs that lead to your home/or inside your home?*

YesNo

How many stairs are there?

Will your dog spend any time in the garage?*

YesNo

Please explain why:

Where will your new dog stay when nobody is home?*

Where will your new dog sleep at night?*

If you drive a pickup truck, would you allow the dog to ride in the back?*

YesNo

What length of time will you allow your new pet to adjust to his new home?*

Are you willing to work through your new pet's issues, if any?*

YesNo

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo

Do you understand that a dog can be an 18 year commitment, and can cost $300 - $1500 per year to care for?*

YesNo

Do you plan to take an obedience class with your dog?*

YesNoNot sure

If yes, where?

What training methods do you plan to use to train your new dog?*

Please explain methods:

Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for?*

YesNo

What circumstances would lead you to give up your new dog?*

If you had to give up your dog, what would you do with him/her?*

If you go away for a few days, or on a vacation, who will take care of the dog?*

How much are you willing to spend on medical bills for your dog?*

What would you do if your vet bills went over this amount?

Are you willing to have a representative from The Animal Protectorates come to see where the dog will be living?*

YesNoOther

the pet damages/destroys something highly treasured by you, your family or friends?*

you find it necessary to move to another home that does not allow pets?*

you plan to get married?*

you plan to start a family?*

a roommate, spouse/significant other, children, family or friends were suddenly allergic to the pet?*

the pet were to suddenly become destructive, acting strangely, and not be happy in your home anymore, even after many years of living with you?*

you suddenly had life changing circumstances that made it difficult and/or impossible to care for this pet?*

Do you have a pet trust/will?*

YesNo

How will you be sure you pet will have a home and be provided for?

What is the contact information for your trustee and guardian?

Is there anything else you would like to tell us?*

Have you ever been charged with animal cruelty (of any kind) or domestic violence?*

YesNo

How did you hear about The Animal Protectorates?*

Note: Adoptions are not approved on a first-come, first-served basis, and completing this application does in no way guarantee adoption of any animal. This form is used for screening of potential adopters for pets in our care and as a first step in getting to know you, your home, family members, lifestyle, and your level of experience with pets. We put many hours into rehabilitating and getting to know these pets in order to make them suitable candidates for adoption. Each pet differs from one another in looks, personality, specific needs, health, and prior experiences. It is our job to ensure the pets are properly matched up with homes where their chance at a ‘forever placement’ is greatest and where they will be happiest. Please understand the average dog can live over 10 years, cat into their late teens and early 20’s, and horses into their late 20's and early 30's. Many factors influence a pets lifespan. It is our policy to ensure that each person who adopts a pet is aware of the responsibilities of pet ownership. We have spent time getting to know these animals, and this is our opportunity to get to know you as a potential home and to assist you in selecting a pet that would best suit you and your home environment. You are making a major commitment when you adopt a pet. IF YOU ADOPT AN ANIMAL FROM US YOU UNDERSTAND AND AGREE THAT IF YOU ARE NO LONGER ABLE TO CARE FOR THE ANIMAL THAT YOU WILL CONTACT THE ANIMAL PROTECTORATES PRIOR TO TAKING ANY ACTION AND FAILURE TO DO SO WILL BE DEEMED A BREACH OF THE ADOPTION CONTRACT.

By typing my name in the box below, I certify that I have read and understand all of the questions on this form. I have answered all questions on this form as truthfully as possible. I understand that if I have purposefully answered any of the questions untruthfully, I may be committing a felony and may be prosecuted to the fullest extent of the law and additionally shall return my pet to The Animal Protectorates - TAPS if the adoption was finalized.

I understand that I assume full responsibility for the welfare of this pet from the date of adoption.

I agree to all of the above terms:*

YesNo

Type your name here:*

Issuing State of your current Drivers License:*

Today's Date*

Date

Please verify that you are human*

Pet Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information

What would you do with the pet if: