Adoption Application for Dogs

Full Name*

First NameLast Name

Age*

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Cellular*

Area CodePhone Number

Phone Number - Home

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Name of dog you are interested in adopting or fostering

If interested in a specific pet, What animal would you like to foster or adopt? blanks

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information*

Household Setting*

RuralCity

Describe the Activity Level in your Home*

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?*

YesNoUnknown

Are all members of your Family agreeable to adopting or fostering a Dog?*

YesNo

Please List any Pets you have Living or Deceased (Please include Name, Breed, Age, Spayed/Neutered, Sex, Up to Date Vaccines, Heartworm testing/prevention, Living/Deceased)*

If you had a pet that is now deceased, what happened to the pet? *

Would you be willing to have a JSCR Team Member call your veterinarian for a reference check? (Please authorize your vet to speak with us)*

YesNo

Veterinarian Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Are you willing and able to medicate your new pet with monthly heartworm preventative and flea and tick preventative?*

YesNo

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?*

YesNo

Have you ever fostered or adopted a pet from JSCR or any other rescue? Type a label
If yes, what organization and what was outcome of fostering/adoption?

Have you had any experience with with an emotionally or physically neglected or abused dog?

YesNo

If Yes please explain. If no, please mark N/A.

Are you willing to use a crate for a dog if recommended?

YesNo

Do you have a fenced yard?

YesNoPartial

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

Do you have any other pets in the house? *

If yes how many and what type of pet; species/breed/sex? *

Are your current pets spayed and/or neutered? ( if applicable)? *

How many hours in a day would your dog be left alone?

Are there children under 15 in the home? *

How will your dog be cared for when you go out of town? *

What are you plans to exercise your dog? Please list any parks near by or trails, how many walks a day, approximate length, activities such as agility

Do you agree to give your dog a 10-14 day decompression period with you before returning your pet to us?*

YesNoDepends on issue

If in the event that you can no longer care for your pet, you agree to surrender the pet to June's Second Chance Ranch.*

I agree

Please provide one non relative reference: Name First Name Last Name Area Code Phone Number

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any of June's Second Chance Ranch animal fostered by me. I certify that the above information is correct, and I understand that the information will be verified. I understand that by submitting this form electronically, I agree to release and covenant to hold harmless June's Second Chance Ranch and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster dog. I accept full responsibility for the dog(s) actions at all times, and release June's Second Chance Ranch from any liabilities or damages that may be incurred because of fostering such dog(s). I agree to have June's Second Chance Ranch complete reference call checks and conduct a home visit inspection to be able to approve my foster application. I agree that if I'm unable to foster the dog(s) anymore that I will return the dog(s) to June's Second Chance Ranch and try to giveJune's Second Chance Ranch a 2 week period to try and find another suitable foster for the dog(s).

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MonthDayYearHourMinutesAM/PM Option

Your name*

Co-Applicant name (if applicable)

Signature*

Adoption Application - DOGS