Adoption Application Form

Name of Dog You Wish to Adopt*

1. Applicant Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

day/month/year

Occupation*

Phone number - Landline*

Phone number - Cell phone*

Email address*

2. Second applicant (if applicable)

If n/a state n/a

Date of Birth

If n/a state n/a

Occupation

If n/a state n/a

Phone Number - Landline

If not applicable put N/A

Phone Number - Cell Phone

If no cell number state N/AFormat: (000) 000-0000.

Email address

Joint annual income (optional)

Please provide your Facebook and Instagram Account Name*

Are there children in the home? if yes, please state their names and ages. If none, say no.*

If no children in the home please state N/A

Who will have the primary responsibility for this dog?*

What are your reasons for wanting this dog?*

If this dog is already matched are you open to another suitable dog match?*

yesno

How would you describe yourself?*

Are there allergies in the family?*

Have you had a dog before?*

If yes, what happened to them?*

If you currently have other dogs, what are their names, breed mix and ages?*

Are your dogs spayed/neutered?*

Do you own other types of pets?*

Are your other pets spayed/neutered?*

Are your other pets up-to-date on vaccinations?*

Your current pets' disposition and behaviour towards other dogs?*

How much will dog food cost monthly?*

How much will vet care cost annually?*

How much will grooming cost you annually?*

How much will dog sitters cost annually?*

We strongly recommend adopters obtain pet insurance. What are your thoughts on this?*

Do you own or rent your home?*

OwnRent

How long have you lived in your current home?*

Do you have a yard?*

yesno

If yes to the above, is it fenced? Please describe fencing. If no, state n/a.

ie fully or partially enclosed, 4 foot chain link fence with 4 ft secure gate, 6 foot wooden fence with 6 foot secure gate, snow fence, 3 foot picket fence, etc.

If you rent, please provide your landlord's information here:

If you do not rent, state n/a

What is your landlord's pet policy?*

If you don't rent, state n/a

Have you ever surrendered or given up a pet?*

YesNo

If you answered "yes" to the above question, please provide details*

If you answered no, state n/a

How would you describe you/your family's schedule?*

Very BusyBusyNot BusyOther

How many hours per day will the dog be alone?*

Where will the dog stay during the day?*

Where will the dog stay at night?*

How many hours exercise (per day) will you provide your dog on weekdays?*

Realistic assessment please

How many hours exercise (per day) will you provide your dog on weekends?*

Realistic assessment please

What form of exercise would you enjoy with your dog?*

Will you crate your dog?*

If you have to leave town, emergency or planned, where would your dog stay?*

Sex*

MaleFemaleNo Preference

Coat*

Age*

PuppyAdultSeniorNo Preference

Size*

Issues you are willing to work on:*

It is essential that any dog I adopt be:*

Check the answer that applies to you*

I need a dog that is already trainedI am a first time dog ownerI have obedience trained beforeI have a lot of experience and could manage a difficult petOther

Under what circumstances would you return a dog?*

How would you deal with behavioural issues such as barking, chewing, destructive behaviour, bathroom accidents indoors, unruly leash behaviours, etc?*

Bad dog habits I can't tolerate are:*

Veterinarian Name and Contact Information (please give them permission to speak to us, as we will be calling them for a reference) *

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Reference #1*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email Address *

example@example.com

Reference #2*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email Address*

example@example.com

Reference #3*

First NameLast Name

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Email*

example@example.com

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?*

yesno

Why do you think this particular dog will be a good fit?*

Is there anything else you would like to tell us about yourself and why you want to adopt this dog?

Do have any other adoption applications in progress? If yes, at what stage are you in the process?*

How did you hear of Backstreet Paws?*

By clicking the submit button, I agree to BackStreet Paws adoption process, and understand I will undergo a homecheck, and interview at the discretion of Backstreet Paws Rescue.
By clicking the submit button, I understand BSP will check my references, including veterinary and personal. I will give my vet's office permission to speak to a Backstreet Paws Rescue representative.
By clicking the submit button, I understand there is an adoption fee associated with the adoption of a dog from Backstreet Paws Rescue and that a $200 deposit applies to any puppy not yet neutered/spayed in addition to the adoption fee. I understand this adoption fee will ensure the organization is equipped to rescue another homeless pet and this fee is non-refundable.
By clicking the submit button, I understand that there is no guarantee that I will be approved to adopt a dog from Backstreet Paws Rescue.
By clicking the submit button, I agree that, if I am approved to adopt a dog from Backstreet Paws Rescue, the adoption will not be complete until I have provided Photo ID, signed the adoption contract and paid the adoption fee. I understand that I will be bound by the terms and conditions of the adoption contract.
By clicking the submit button, I consent to Backstreet Paws Rescue collecting and using my personal information for the purpose of contacting me to keep me informed of important campaigns and to ask for support, and will from time to time telephone, email and send mail to me.
By clicking the submit button, I verify all of the above information is true and accurate.

Date*

Date

Signature of Potential Adopter *

Adoption Application

Type of Dog You Are Looking For