Rescue Dog Adoption Application

Chimera Sanctuary & Rescue Dog Adoption Application
Chimera Sanctuary & Rescue is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. Chimera Sanctuary & Rescue is completely funded through fundraising efforts and public donations. All of our pets are cared for by volunteers and receive complete medical care, which includes worming, vaccinations, spaying/neutering prior to their adoption.
This questionnaire is designed to help Chimera Sanctuary & Rescue and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Chimera Sanctuary & Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!
Applicant Information
Your Name and the Name of the dog you are interested in: *
Your age: *
Street Address: *
City, State, Zip *
Home Phone:

Area Code Phone Number
Work Phone:

Area Code Phone Number
Cell Phone:

Area Code Phone Number
E-mail:
Employer:
Provide 3 Character references and phone numbers:
Household Information
Are all members of your household in agreement with this adoption? *

Yes No Don't Know
Who will be the pet's primary caregiver? *
Do you live in a *

House Apartment Condo Mobile Home
Do you own or rent? *

Own Rent
If rent, provide name and phone number of landlord:
Does your landlord allow dogs?

Yes No
Are there any restrictions from your landlord or subdivision? *

Number of pets Size or weight restrictions Breed restrictions None
Do you have a fully fenced yard? *

Yes No
Height and type of fence
Do you have any of the following?

Underground fence Kennel Dog Run
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?

Yes No
Does anyone in your home have allergies to dogs or have asthma? *

Yes No
Current/Previous Pet Information
List any pets you own or have owned in the past five years, and their ages
How many of these pets are spayed/neutered?
Where are these animals now?
Have you adopted from an animal welfare group before?

Yes No
If yes, what group?
Have you ever given up a pet?

Yes No
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic:
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato) *
Are you aware of crate training? *

Yes No
Have you ever house-broken a dog or puppy before? *

Yes No
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? *
Where will your new pet sleep at night? *
How will you supervise the dog's outdoor activity? *
Where will your new dog stay when nobody is home? *
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? *

Yes No
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *

Yes No
Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for? *

Yes No
Do you plan to take an obedience class with your dog? *

Yes No Not sure
If yes, where?
Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for? *

Yes No
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? *
How did you find out about Chimera Sanctuary & Rescue? *

Adoptapet.com Petfinder.com Facebook Friend/Family Member Other website PetSmart
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
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Chimera Sanctuary & Rescue Dog Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information