Rescue Dog Adoption Application

Shelter Animals Matter, Inc

Dog Adoption Application
Shelter Animals Matter is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of abandoned, neglected and abused former shelter animals. We are completely funded through fundraising efforts and public donations. Adoption fees are considered a tax deductible donation. All of our pets are cared for in loving foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption. All pets available for adoption have been thoroughly assessed and deemed adoptable.
This questionnaire is designed to help Shelter Animals Matter and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. We reserve the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions.
Applicant Information
Name of the dog you are interested in:*
Your full name:*
Your age:*
Street Address:*
City, State, Zip*
Home Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:
Employer:
Character reference and phone number:
Household Information
Are all members of your household in agreement with this adoption?*

YesNo
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If you rent, provide name and phone number of landlord:
Does your landlord allow dogs?

YesNo
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Do you have a fully fenced yard?*

YesNo
Height and type of fence
Do you have any of the following?

Underground fenceKennelDog Run
How many adults are in your household?*
How many children are in your household?*
If children, what are their ages?
Have your children been around animals before?

YesNo
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
Current/Previous Pet Information
List all pets you own and their ages
How many of these pets are spayed/neutered?
Have you adopted from an animal welfare group before?

YesNo
If yes, what group?
Have you ever given up a pet?

YesNo
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic:
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Are you aware of crate training?*

YesNo
Have you ever house-broken a dog or puppy before?*

YesNo
If the dog has an "accident" in your home, what type of correction do you plan to use?*
How many hours each day will your new pet be home alone?*
Where will your new pet sleep at night?*
How will you supervise the dog's outdoor activity?*
Where will your new dog stay when nobody is home?*
What length of time will you allow your new pet to adjust to his new home?*
Are you willing to work through your new pet's issues, if any?*

YesNo
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo
Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for?*

YesNo
Do you plan to take an obedience class with your dog?*

YesNo
Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for?*

YesNo
What circumstances would lead you to give up your new dog?*
If you had to give up your dog, what would you do with him/her?*
I understand that if I'm approved I assume full responsibility for the welfare of this pet from the date of adoption.
Should be Empty:

Shelter Animals Matter, Inc

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information