Adoption Application and Contract

ADOPTION APPLICATION

Operation Save A Shelter Dog

6150 Blackwater Rd, Zuni, VA 23898

757-375-5523

operationsaveashelterdog@gmail.com

PayPal: OperationSaveAShelterDog@Gmail.com

Remember this is a lifelong commitment. After answering all the questions, please ask yourself if you are ready to commit to the this companion for the duration of their life? Can you give this companion the needed time to decompress and not have unrealistic expectations? Please be honest as this is their life too!!

Operation Save a Shelter Dog is a non profit rescue organization for homeless dogs, sick, and injured dogs. It is our goal to get these dogs healthy and place them in permanent, loving homes where every member of the household is committed to their lifelong care. If you are willing to take on this responsibility, please complete the application below. Your application will be reviewed, and if qualified, we will proceed with the adoption.

I certify that the information provided on this application is complete, true and accurate to the best of my knowledge. I understand that providing false information may void this application and result in forfeiture of the adopted animal, as well as any adoption fees paid
Date *

Month Day Year
Date
Dog's Name You Are Applying To Adopt: *
SECTION 1 - PERSONAL INFORMATION
Applicant's Name *

First Name Last Name
Date Of Birth *

Month Day Year
Date
Spouse or Co-Applicant's Name (If Applicable)

First Name Last Name
Date of Birth of Co-Applicant

Month Day Year
Date
Cell Phone Number *
Please enter a valid phone number.
Cell Phone Number of Co-Applicant
Please enter a valid phone number.
Secondary Number (Home/Other)
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Email of Co-Applicant
example@example.com
Are You Willing to Have a Home Visit Before and/or After Adoption? *

Yes No
Do You Own Or Rent Your Home? *

Own Rent Other
If You Own Your Home Is There An HOA?

Yes No
Does Your HOA Have Breed Restrictions?

Yes No
If You Are Renting, Please Provide Landlord's Name and Phone Number
What Is Your Landlord's Pet Policy
If Pet Deposit Is Required, Have You Paid?

Yes No
Employer Name and Phone Number *
Have You Ever Been Accused/Convicted of Animal Cruelty *

No Yes
SECTION 2 - LIVING ARRANGEMENTS
If You Have To Move In The Future Where Dogs Are Not Allowed, What Would Happen To Your Dog?
Under What Circumstances Or Life Changes Have You Had To, Or Would you Have to Give Up A Pet (Select All That Apply) *

Getting Married Getting Divorced Having a Baby Going Back To Work Going Back To School Family Illness Financial - Lost Home Financial - Lost Job Moving Travel Other Reasons None
If You Selected A Response To The Question Above About Giving Up A Pet, You Can Provide Additional Detail Here.
If You Had To Give Up Your Pet and the Rescue Could Not Take It Back Immediately What Would You Do? *

How Many People Currently Live In The Home? *

	Number of Adults	Number of Children	Ages of All Children In The Home	Is Anyone Allergic To Dogs?
Residents In Home

What Role Will The Adopted Pet Play In Your Life? *
Do You Provide Child or Pet Care In Your Home? *

Yes No
Describe The Activity Level In Your Home: *
Where Will Your Adopted Dog Primarily Live: *

Inside Only Outside Only Mostly Outside Both Inside and Outside
If Both, Please Explain With Additional Details
How Many Hours Per Day Will Your Dog Usually Be Left Alone Due To Work, School, Etc.? *

1-4 Hours 4-8 Hours 8-12 Hours More Than 12 Hours
Will Your Pet Be Crated *

No, I Do Not Use Them Yes, When I Am Not Home Yes, At Night Yes, When I Am Not Home And At Night
Do You Have A Fenced Yard That Is Fully Enclosed On All Four Sides? *

Yes No Electric Other
If Yes, How Tall Is Your Fence

4 Foot 5 Foot 6 Foot Taller Than 6 Foot
If Yes, What Is Fence Material (Select All That Apply)

Chain Link Vinyl Wood Wire Other
SECTION 3 - TRAINING AND COSTS
Owning A Dog Comes With Some Recurring Monthly And Annual Expenses. Have You Thought About Those, And Feel You Are Financially Prepared To Pay For These Expenses? *

Yes No
Do You Own a Vehicle to Get Animal to Vet *

Yes No
If You Go On Vacation or are Deployed, What is Your Plan For This Animal? *

Board Pet Sitter Family Friend Other
Adopted Dogs Usually Have Some Potty Accidents In Their New Home For A Short Period Of Time And Puppies Need To Be Potty Trained. How Will You Handle This? *
Adopted Dogs May Need Some Additional Behavior Training, Depending On Their Background And Whether They Were Previously Living In A Home. What Behaviors Would You NOT Be Able to Live With? (Please Select All That Apply) *

Barking Chewing Destruction Escaping Jumping On People Potty Accidents I Can Handle All Of Them
If The ADOPTED Dog Displays Any Of The Behaviors You Selected Above, How Will You Handle It?
Have You Ever Had To Surrender A Pet You Owned To Any Animal Shelter, Including a Low or No Kill Shelter? *

Yes No
If You Answered Yes To Surrendering A Pet, Please Provide Detail:
Have You Ever Lost A Dog To Escape Or Accident: *

Yes No
If You Answered Yes To Losing A Dog To Accident or Escape, Please Provide Detail:
SECTION 4 - HISTORY WITH CURRENT AND PRIOR PETS
When Was The Last Time You Owned A Dog? *
How Many Dogs Have You Owned In Your Life? *
How Many Dogs Do You Currently Own? *
How Many Cats Do You Currently Own? *

List Of CURRENT DOGS Or CATS You Own That Are Living At Your Home, Inside And/Or Outside.

	Type of Pet	Pets Name	Breed or Breed Mixes	Current Age	Is Pet Spay or Neutered?	Is Pet Current On Vaccines?	Is Your Dog On Year Round Heartworm Prevention?	Where Does The Pet Primarily Live?
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Pet 6

If You Indicated A Pet Lives Inside And Outside, Please Provide Details On When It Is Inside And When It Is Outside.
Current Pet(s) Disposition And Behavior Towards Other Dogs? Please List Any Positive Information Or Possible Concerns If Introducing A New Dog To Your Current Pets.
Do You Plan To Give The Newly Adopted Pet Proper Decompression Time and Slow Introductions To Current Pets? *

Yes No
What Heartworm Prevention Do You Use, And Where Do You Purchase It? *
What Flea Prevention Do You Use, And Where Do You Purchase It? *
Please List Name and Phone Number To Your Veterinarian/Vet Clinic You Use For Your Current Pets and Pets That Have Passed In the Last Year. If Records Are Under Another Name Please Provide. PLEASE CONTACT VET AND PROVIDE PERMISSION FOR OPERATION SAVE A SHELTER DOG TO BE PROVIDED YOUR PET(S) CURRENT INFORMATION.
If There Is Anything Else We Should Know About You, Current, Or Prior Dogs, Or Your Application, Please Enter It Here.
Signature *

Clear
Co-Applicant Signature

Clear
Should be Empty:

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SECTION 1 - PERSONAL INFORMATION

SECTION 2 - LIVING ARRANGEMENTS

SECTION 3 - TRAINING AND COSTS

SECTION 4 - HISTORY WITH CURRENT AND PRIOR PETS