Adoption Application - Adopt Korean Rescue

Congratulations on choosing to adopt a Korean rescue dog! Please complete the following form to submit your adoption application.
Please provide the name(s) of the dog(s) you're interested in adopting*
Personal Information

We respect your privacy and the information you provide in this application will not be shared.
Applicant's Information
Applicant's name*

First nameLast name
Age*
Preferred pronouns or salutation*
Partner/Spouse Information - If not applicable, please write n/a
Partner/Spouse's name (if applicable)

First nameLast name
Partner/Spouse's age
Preferred pronouns or salutation
Address*

Street address

Apartment, suite, etc.

CityProvince / State

Postal / ZIP codeCountry
How long have you lived at this address?*
Number of people living at this address*
Including yourself
Number of children and ages*
If not applicable, please write N/A
Please list any other household members*
If not applicable, please write N/A
Are any household members allergic to animals?*

YesNoUnsure
Email address*
Alternate email address
Phone number*
Best number to reach you
Alternate phone number
Second best number to reach you
Best time to call*
Please share your social media profiles*
Your support is important and appreciated
Occupation*
Partner/Spouse's occupation*
If not applicable, please write N/A
Are you a Canadian/US citizen or permanent resident?*

YesNo
Immigration Status*
Would you please provide your annual household income?
Describe your lifestyle*
e.g. very active, active, homebody
Describe other visitors to your home with which the dog will come into contact*
e.g. family, pets, roommate
If approved, when can you take possession of the dog?*
How far are you willing to travel to meet the dog?*
Have you ever taken an animal to a shelter or released it to another party? **

YesNo
Please provide details*
Have you or any member of your household ever been convicted of neglect or cruelty to animals?*

YesNo
Please provide details*

Veterinarian Information

Please contact the veterinarian that you have listed to let them know a representative of Adopt Korean Rescue will be calling for a reference
Do you have a regular veterinarian?*

YesNo
Clinic name*
Veterinarian's name*

First nameLast name
Clinic address*

Street Address

Apartment, suite, etc.

CityProvince / State

Postal / Zip CodeCountry
Clinic phone number*
Veterinarian clinic phone number
Date of your last vet visit*

YearMonthDay
Name the animals that are listed at the vet's office*
Pet's name and owner's name
Is your vet aware that you are considering adopting a dog?*

YesNo
As you do not have a regular veterinarian, please describe your healthcare plan for the dog*

References

Please provide two personal references who are not related to you by either blood or marriage
Reference 1

First nameLast name
Phone number*
Reference #1 phone number
Email address*
Relationship*
Reference 2

First nameLast name
Phone number*
Reference #2 phone number
Email address*
Relationship*
Is there anything else you would like to tell us that you think would be important when considering your application?
Many factors determine which applicant will be matched with a particular dog. AKR’s goal is to place all animals into homes that will best suit their individual needs, and to match the dog to the right applicant. Please ask for clarification if you have any questions.
Agreement
I,applicant's name*, certify that the information provided on this form is true and correct. In submitting this document, I am granting permission for Adopt Korean Rescue (“AKR”) representatives to contact all stated references and veterinarians. I also understand that a home visit will be conducted prior to being approved to adopt a dog from AKR. I agree to provide updates on my adopted dog through electronic sources (e.g., email, Facebook) where technology exists. I am physically and financially able to care for this animal. I understand that proper food, water, shelter and veterinary care are necessary and may be costly, and I am able to meet these requirements. If, upon inspection, AKR finds information contained in this application to be false, AKR reserves the right to refuse my application or remove the animal from my premises without a refund of any fees paid. AKR reserves the right to decline an applicant as its primary interest is the wellbeing of the animal. I understand I will be required to sign an adoption agreement (contract) and pay an Adoption Fee prior to or at the time of adoption.
Signature*

Clear
Sign date*

YearMonthDay
Please verify that you are human*
Should be Empty:

Personal Information

Adoption Preferences

Home Information

Pet Information

Dog-Specific Information

Veterinarian Information

References

Agreement