My Why Rescue Dog Adoption Application

1
My Why Rescue takes in abused, neglected, and abandoned animals, globally and locally. We make every attempt to screen our animals for health, behavior and temperament issues. Certain types of problems may not demonstrate themselves until the animal is in a home environment. For these reasons we cannot guarantee the behavior, health or temperament of any animal.
2
Dog you are interested in: * This field is required.
3
First and Last Name * This field is required.
4
Primary Phone Number * This field is required.Best number to call
5
Secondary Phone Number
6
Address, City, State, Zip * This field is required.
7
Email Address * This field is required.
8
Type of Residence * This field is required.
9
Do you own or rent * This field is required.
10
How long have you lived here? * This field is required.
11
If you are renting, please provide you landlord's name and phone number
12
Is this the first time you have owned a dog as an adult? * This field is required.
13
Please provide your veterinarian's name and phone number * This field is required.
14
Please list all animals that currently live in your home. Name, breed, age, sex, spayed/neutered. * This field is required.
15
Please list all persons living in the home * This field is required.
16
Type a question* This field is required.Are you a smoker? Some of our pets depending on their health issues cannot be in a home with smokers.
YESNO
17
Does anyone in your house have allergies to animals? * This field is required.
18
Does anyone in the home have a medical condition that will stop them from providing care to the animal? * This field is required.
19
Please describe what kind of dog you are looking for (long or short hair, size, weight, male/female, age) * This field is required.
20
Please select all the qualities that you are looking for in a dog* This field is required.
Easy on a leash
Lap dog
Confident
Playful
Enjoys car rides
Active
Protective
Rough houser
Good with other dogs
Independent
Gentle
Energetic
Good with cats
Calm
Dependent
Quiet
Enjoys hiking, jogging, running
Good with children
Adult dog that is settled
21
Do you plan to crop the ears or tail or debark your new dog?* This field is required.
Yes
No
22
Would your new dog have any of the following visiting:* This field is required.
children under 10
teenagers
male dogs
female dogs
cats
livestock
horses
none
23
What are some training needs that you do not wish to encounter that are reasons why you would not adopt.* This field is required.
Housebreaking
Escaping
Digging
Chewing
Excessive barking
Protective
Leash pulling
Jumping
Stubborn
Food aggression
Toy aggression
Shy/fearful
Plays too rough
Needs a lot of attention
Other
24
There are some behaviors that require patience, formal training, or prior dog experience. If your new dog does display any of these behaviors, how will you go about teaching him/her?* This field is required.
Contact a professional
Use a book
Google
Personal knowledge
Other
25
How would you describe your household?* This field is required.
very active
lots of kids visit
some activity
frequent adult visitors
quiet
Other
26
When you are home, where will your new dog be?* This field is required.
Loose in the home
Crate in the home
Loose outside
Tied up outside
Outside kennel/pen
Within fenced yard
Garage
Doghouse in yard
Basement
Other
27
When you are NOT home, where will your new dog be?* This field is required.
Loose in the home
Crate in the home
Loose outside
Tied up outside
Outside kennel/pen
Within fenced yard
Garage
Doghouse in yard
Basement
Confined to a room
Runner in yard
Doggie day care
Other
28
All dogs require exercise. How will your new dog get adequate exercise?* This field is required.
Run in yard
Outdoor kennel/pen
Fenced yard
Daily leash walks
Loose outside
Off leash dog park
Hiking/jogging
Mid-day dog walker
Doggie day care
Other
29
Do you have a steady stream of income?* This field is required.
Yes
No
30
If you are employed, please indicate where you work * This field is required.
31
There are additional expenses for pets for routine care and possible unexpected medical costs. Are you prepared to be financially responsible for you new pet?* This field is required.
Yes
No
32
It may take weeks for the new dog to adjust to a different environment. It may even require keeping the animals separate to introduce them properly. Are you prepared to handle this?* This field is required.
Yes
No
33
In a new environment it can be hard to determine if an animal is housebroken. Will you be able to tolerate accidents and train the pet?* This field is required.
Yes
No
34
Are all family members in agreement about adopting a dog?* This field is required.
Yes
No
35
Have you or any member of your household been subject to legal action for cruelty to, neglect of, or abandonment of any animal?* This field is required.
Yes
No
36
First reference name/number * This field is required.
37
Second reference name/number
38
Third reference name/number
39
Pictures needed of home for approvalPlease provide pictures of your home (common living areas and backyard)
40
Home checks are required prior to adoption. Will you allow us to complete a home check?* This field is required.
Yes
No
41
Are there any topics that you would like to discuss with our adoption coordinator? * This field is required.
42
I understand that purposeful falsification of the information contained in this form will result in automatic denial of an adoption, or subsequent confiscation of already adopted pet (s). I certify that the information I have provided herein is accurate and I authorize My Why Rescue to investigate all statements made on this questionnaire. I understand that My Why Rescue makes no representation or guarantee about any animal's temperament, behavior, health or any combination thereof. My Why Rescue is not held liable for any future injury or damage, which may be caused by any adopted animal, nor is My Why Rescue responsible for any illness or medical malady, which may befall the animal subsequent to adoption. My Why Rescue reserves the right, at our sole discretion, to refuse any applicant for any reason.* This field is required.
I understand
I do not understand
Should be Empty: