• EarthMother Rescue Dog Adoption Application

  • EarthMother Rescue is an all-volunteer, 501(c)3 non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. EarthMother Rescue is completely funded through fundraising efforts and public donations. All of our pets are cared for in foster homes and receive complete medical care, which includes but not limited to worming, vaccinations, spaying/neutering and microchipping prior to their adoption.

  • Applicant Information

  • This questionnaire is designed to help both EarthMother Rescue and you determine if a specific dog is the right fit for you and your household. All adopting households are required to complete this form prior to adoption.


    EarthMother Rescue reserves the right to deny any adoption based on responses to this questionnaire, our experience with an adopter or someone within their household, and/or interviews conducted prior to adoption.

     
    EarthMother Rescue also reserves the right to renegotiate or reclaim an animal adopted through our organization if information comes to light indicating mistreatment, abuse, neglect, unauthorized rehoming (without notification to our organization), or failure to provide necessary veterinary care for a dog previously placed in your home.

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Household Information

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

  • Employer Information

  • Began Employment
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.

  • Family Dynamics

    Tell us about your household
  • Do you live in a*
  • Do you own or rent?*
  • Does your landlord allow dogs?
  • Are there any restrictions from your landlord or subdivision?*
  • Do you have a fully fenced yard?*
  • Do you have any of the following?
  • Have your children been around animals before?
  • Does anyone in your home have allergies to dogs or have asthma?*

  • Current/Previous Pet Information

  • Have you adopted from an animal welfare group before?
  • Have you ever given up a pet?

  • Health Care

  • New Pet Information

  • Are you aware of crate training?*
  • Have you ever house-broken a dog or puppy before?*
  • Are you willing to work through your new pet's issues, if any?*
  • Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*
  • Do you understand that a dog can be an 18 year commitment, and can cost $400 - $1200 per year to care that should include dental care?*
  • Do you plan to take an obedience class with your dog?*
  • Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for?*
  • How did you find out about EarthMother Rescue?*

  • ✳️I understand that I assume full responsibility for the health, love, welfare and commitment to this pet from the date of adoption. By clicking the submit button, I agree to the adoption process, would be willing to undergo a homecheck if necessary, and understand that if I no longer want my pet, or am no longer able to care for my adopted pet at any time, I will be directed to surrender my pet back to EarthMother Rescue. I understand that I may not rehome my adopted pet to anyone without first getting approval by EarthMother Rescue. I agree to update my new pets microchip information within thirty days to my details and have EarthMother Rescue as an additional back up number on the microchip file in case I am unreachable or unavailable. By clicking the submit button, I verify all of the above information is true and accurate and understand that I am entering a contractual agreement with EarthMother Rescue and agree to the terms listed.

  •       This is a fill in the field. Please add appropriate fields and text.

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