Stars and Stripes Dog Adoption Application

Stars and Stripes Dog Rescue

Dog Adoption Application
We are based in Orangevale, CA, just outside Sacramento. If you are within 50 miles of Sacramento, we would love for you to join our team. Submitting this application does not mean you are commiting to a dog, nor does it guarantee you will get that dog. It is simply a tool we use to help both you and us identify a good potential match for your family and lifestyle. A successful adoption depends on selecting the right dog for your household and a good understanding of the dog's needs and care requirements. Please help us with this process by answering the following questions fully & completely.

THANK YOU!
Name of the dog you want to adopt *
Adopter's Name *
First & Last Name
Co-Adopter's Name
First & Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Adopter's E-mail *
Co-Adopter's E-mail *
Phone Number *

Area Code Phone Number
Phone Type *

Cell Home Work
Names and ages of all permanent residents of your home (adults/children) *
Do you currently have any pets? *

Yes No
If you currently have pets, please list them below.
Are your current pets altered?

Yes No Will be within the next 30 days, appointment has been scheduled. (We will call your vet to verify this.)
If your current pets are not altered, please explain why below.
Vet reference (please call your vet and give permission to release information to us) *
Vet name, address & phone number
One Personal References *
Are you planning to move in the near future? *

Yes No
If moving soon, to what city/state?
When will you be ready to adopt this dog? *

Today This weekend Within a week Within a month Not ready yet, just researching
Are you in contact with any other rescues or shelters about a specific dog? *

Yes, application is pending Yes, just an email inquiry, no app yet No, but I am looking at several dogs online No, I am only interested in this particular dog
Are you going to meet another dog? *

Yes No
If so, when?
Is anyone in your home allergic to dogs? *

Yes No
Does anyone in your home fear dogs? *

Yes No
Does anyone in your home smoke? *

Yes No
Are you familiar with dog regulations in your area? *

Yes No
If you answered no to the question above, please contact your town/county/condo assoc and ask them what the regulations are.
If yes, please describe local dog regulations and restrictions:
I/We live in a *

Single Family Home Duplex/Twin Condo/Townhome Trailer Apartment
Do you rent or own this property? *

Rent Own
Renters, have you contacted your landlord to find out if there's any restrictions on the kind or size of dog you can have?

Yes No Not yet, but I will It's written in our lease
If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any limitations. If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.
Approximate square footage of your home *

Less than 800 square feet 800-1,000 square feet 1,000-1,500 square feet 1,500-2,000 square feet Over 2,000 square feet
Do you have a yard? *

Yard, fenced with a vertical fence Yard, fenced with invisible fencing Yard, no fence No yard (apartment/condo/townhome)
If vertical fence, what is your fence height?

2' high 3' high 4' high 5' high 6' high
Annual Household Income *

Under $20,000 $20,000-$30,000 $30,001-$50,000 $50,001-$70,000 $70,001 or higher
Do you work outside the home? *

Yes No One applicant is home/works from home We work different shifts
If you both work outside the home, how many hours per day are you away?
How many hours per day will this dog be alone? Please explain. *
Have you discussed this adoption with all members of your household? *

Yes No Yes, adults have discussed. Kids don't know yet.
We will be speaking to all adult residents to confirm everyone is aware of this application process and wants to have a dog added to the family. Please do not submit this application if you are "trying to talk someone into" adopting this dog or think "once they meet the dog, they will want one" or "I'm getting this dog as a surprise birthday present for them." In those scenarios, you are welcome to email us to discuss the dog, but we would like all adults in the home to be involved in that email discussion.
Based on the description in the dog's bio, do you feel pretty confident that you will be likely to adopt this dog upon meeting it? *

Yes No Not sure
Upon meeting the dog, what would give you cause to not want to adopt it? Please explain. *
How much do you feel you can reasonably afford and would be willing to spend on your dog per year (for things like veterinary care, licensing, ID tag, food, toys, crate, other supplies, training, pet sitting, etc)? *
What activity/energy level do you prefer? *

Wild and crazy is cool Leash trained daily jogging partner would be excellent Medium energy, plays a bit then hangs out with you Low energy, walks slowly on leash, a total couch potato
Please check all that apply. I want to adopt this dog... *

As a family pet To breed with my dog To train/use for hunting To train/use for agility To train/use as a therapy dog To train/use as an assistance dog for the disabled To use as a guard dog For a jogging/hiking partner To interact with lots of friends/family As a gift for a friend, partner, or family member As a companion for my dog(s) As a companion for my cat(s) As a companion for my child/children
Please check all that apply. My adopted dog will...

Be kept outside most of the time Be kept indoors most of the time Be left outside during the work day while we are away Be kept inside while we are away Be crated when we are not home Have free reign of the house when we are not home Be taken to formal obedience classes Be trained by me/us Take frequent car rides with us Be kept on a lead line/cable in the yard Be mostly interacting with adults Be interacting frequently with children under 8 Be interacting frequently with older children Must be housebroken prior to adoption Will be housetrained by us Will be walked more than one mile per day every day Will be walked occasionally Be attending formal group obedience classes with us Be trained by us without the advice of a trainer Have private sessions with a trainer as needed Be attending agility classes Be taking frequent car rides/trips with us Be boarded when we go on vacation Stay with family when we go on vacation Be given away to someone else if we feel it's not a good match for us Be turned in to a shelter if we can't keep it Be going camping with us Be going on boat trips with us Be outside with a dog house in a fenced area Be outside chained/tethered to a dog house Be free roaming on the farm (unfenced)
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog? *

Housebreaking Chewing Jumping Pulling on leash during walks Counter surfing Obedience training Fear of men Fear of women Fear of children Mouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training) Growling Barking Rough play with my dog High activity level Food/toy aggression/not willing to share with other dogs Food/toy aggression with people Whining/crying Counter surfing Blindness Limited Sight Deafness Separation Anxiety Diabetes Special Diet Long Term Medication Incontinence / Leaking Urine Taking classes with the dog Gets stressed/carsick when riding in vehicle Doesn't know how to climb stairs Can't climb stairs due to age/arthritis/health issues Heart condition Skin allergies Food allergies Trimming nails Yeast on coat or in ears Ear mites Fleas Ticks Heartworm preventative Annual heartworm/lyme combo testing I will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.
What would cause you to return a dog? *
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family? *
How do you plan to integrate this dog into your family? *
What would you do if you discovered after adoption (at any time during the life of the dog) if your vet diagnosed an expensive health condition? *
Do you plan to get pet health insurance? *

Yes No I wasn't aware this was available. I will look into it.
How long have you been looking for a dog? *
Do you plan to take formal obedience classes? *

Yes No
Additional reference (if desired)
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog? *
I understand that completing this application does not guarantee I will be allowed to adopt a dog, and that the application is a tool to help Stars & Stripes Dog Rescue determine if this dog and my family are a good fit for each other. I acknowledge that all information provided on this form is true and correct. I understand that any misrepresentations may result in my not being approved and/or removal of the adopted dog from my possession. I also certify that I have never been convicted of animal cruelty or neglect. I agree to allow a representative from Stars & Stripes Dog Rescue to contact my vet for a reference and also agree to allowing a home visit prior to adopting this dog. If I am approved to adopt a dog, I agree to pay a non-refundable adoption fee and hand sign an adoption contract at the time of adoption. I understand that all dogs adopted from Stars & Stripes Dog Rescue will be spayed/neutered, heartworm tested, fecal tested, and vaccinated prior to adoption.
Please read the above, check this box, sign, and click Submit. *

I/We have read and understand all of the above.
Applicant's Signature *
Co-Applicant's Signature
Signature date *
After you submit this form, we will review the submission and contact you as soon as we can. Feel free to email us with any questions: starsandstripesdogrescue@gmail.com Stars & Stripes Dog Rescue reserves the right to reject any application based on information obtained during this screening process. Please understand that our primary goal is the health, happiness, and safety of our rescued dogs. Susan Aimes, 916 847 9986.

We are Registered, 501(c)3 Non-Profit Organization Focused on Animal Rescue and the Reduction of our Pet Overpopulation.
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Stars and Stripes Dog Rescue