Dog Adoption/Foster application Form

Adoption Application
Full Name (Required field)*

First NameLast Name
E-mail (Required field) *
Address (Required all fields)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*

Area CodePhone Number
Birth Date *

MonthDayYear
Are you employed/retired? (Required field)*

Employed full timeEmployed part timeRetired
Where are you employed? How long?*
Do you own your own home? (Required field)*

YesNo
If renting: Landlord name and contact number*

Namecontact number
List names & ages of all whom reside or stay in your home:*
If no children, do you plan on having children or will children be visiting the household frequently? (Required field)*

YesNo
What is your reason for wanting to adopt a dog? (Required field)*

HousepetCompanionCompanion for petGiftGuard DogOther
If other, please explain:
Veterinarian information*

Clinic namecontact number
How many total hours will your new pet be left alone during the day? (Required field)*
If adopting a puppy, where would the puppy be kept when alone?*
Do you have a fenced yard? (Required field)*

YesNo
Will your adopted dog or do your current dogs be put on a tie out? (Required field)*

YesNoNot sure
Are any members of your household allergic to animals? (Required field)*

YesNo
Over the past 5 years, how many pets have you owned? (Include current pets)*
List all pets living with you and those deceased: name, species, age*
Are your present pets up-to-date on their annual vaccines? (Required field)*

YesNoN/A
If no, please explain:
Are your present pets spayed or neutered? (Required field)*

YesNoN/A
If no, please explain.
How much are you financially prepared to spend for routine/emergency medical care, licensing, etc? (Required field)*
Do you have a swimming pool:*
If yes, what steps will you take to ensure your new dog's safety:*
What plans do you have for your new pet when you are on vacation? (Required)*
Which dog(s) are you interested in?*
Can/Will you provide your dog with monthly heart worm/flea/tick prevention? (Required field)*

YesNo
If your dog displays behavioral problems (such as jumping on people,excessive barking, potty accidents, etc.) how would you go about correcting the behavior? (Required field)*

Contact a ProfessionalUse a bookPersonal KnowledgeOther
If other, please explain:
Is your entire immediate family in agreement with the decision to bring a new pet into your home? (Required field)*

YesNo
If anyone is NOT, please explain:
Where will your dog spend most of his/her time? (Required field)*
If you selected outdoor, would your dog be supervised?*

YesNo
Where will your dog eat?*
Where will your dog sleep?*
Please provide 2 personal references (only 1 can be a relative) that can testify to your responsibility and ability to care for your animals. This is required or your application cannot be approved.
Reference #1 (Required field)*
First and Last Name & Relationship to Self
Reference # 1 Phone Number (Required field)*

Area CodePhone Number
Reference #2 (Required field)*
First and Last Name & Relationship to Self
Reference #2 Phone Number (Required field)*

Area CodePhone Number
Please note if you are applying to foster or to adopt. *
Please remember, it may take approximately 2 to 3 business days for us to get back to you.
Thank you so much for wanting to rescue from Shar Pei Nation Rescue!!
Signature

Clear
Should be Empty:

Adoption Application

Please provide 2 personal references (only 1 can be a relative) that can testify to your responsibility and ability to care for your animals. This is required or your application cannot be approved.

Please remember, it may take approximately 2 to 3 business days for us to get back to you.

Thank you so much for wanting to rescue from Shar Pei Nation Rescue!!