Adoption Application
Dogs/Puppies $150.00 + tax . Cats/Kittens $75.00 + tax
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long at this address?:
*
Are you planning on moving within the next 6 months?
*
Yes
No
If yes, what are your plans for your pets if you move?
Home Phone Number
-
Area Code
Phone Number
Cell Phone Number
-
Area Code
Phone Number
Name of Employer:
Work Phone Number
-
Area Code
Phone Number
Up until what time of night can we contact you via phone?
*
E-mail
*
Are you 18 years of age or older?
*
Yes
No
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Do you own your own home?
*
Yes
No
If no, name and phone # of landlord:
Type of Dwelling:
*
Please Select
House
Apartment
Condo
Mobile Home
Name and age of ALL occupants in household (including yourself):
*
If no children, do you plan on having children or will children be visiting the household frequently?
*
Yes
No
What is your reason for wanting to adopt a dog?
*
Housepet
Companion
Companion for pet
Gift
Guard Dog
Other
If other, please explain:
How many total hours will your new pet be left alone during the day?
*
How many total hours will your new dog be outside alone during the day?
*
If adopting a puppy, where would the puppy be kept when alone?
Do you have a fenced yard?
*
Yes
No
If yes, which type of fence?
*
Wood
Chain Link
Split Rail
N/A
If yes, how tall is your fence?:
*
Do you have locks and/or latches on all your gates?
*
Yes
No
N/A
Will your adopted dog or do your current dogs be put on a tie out?
*
Yes
No
Not sure
Are any members of your household allergic to animals?
*
Yes
No
If yes, please describe:
Who will have chief responsibility for the care of your new pet?
*
Over the past 5 years, how many pets have you owned? (Include current pets)
*
Please Select
0
1
2
3
4
5
6+
List each individually including breed, age, still living with you? (if not, why?)
Have you and your spouse (if applicable) ever owned a pet together?
*
Yes
No
N/A
If yes, when?
Have you ever lost or given away a pet?
*
Yes
No
If you currently own a dog or cat, how does he/she react to new pets?
Are your present pets up-to-date on their annual vaccines?
*
Yes
No
N/A
If no, please explain:
Are your present pets spayed or neutered?
*
Yes
No
N/A
If no, please explain.
Were your previous pets spayed or neutered?
*
Yes
No
N/A
If no, please explain.
How much are you financially prepared to spend for routine/emergency medical care, licensing, etc?
*
What plans do you have for your new pet when you are on vacation?
*
Which dog(s) are you interested in?
*
Age of animal you would consider adopting: (check all that apply)
*
Puppy
Young
Adult
Special Needs
Senior
Bonded Pair
Can/Will you provide your pet with monthly heart worm/flea/tick prevention?
*
Yes
No
Who is your current or most recent veterinarian? Please provide their NAME and PHONE NUMBER:
*
If your dog displays behavioral problems (such as jumping on people,excessive barking, potty accidents, etc.) how would you go about correcting the behavior?
*
Contact a Professional
Use a book
Personal Knowledge
Other
If other, please explain:
What type of solution would you be willing to try if housebreaking accidents continue after the first week (check all that apply)?
*
Try crate training
Use positive enforcement
Use potty pads
Have dog examined by vet
Use a dog door
Return dog
None
Other
If other, please explain:
Is your entire immediate family in agreement with the decision to bring a new pet into your home?
*
Yes
No
If anyone is NOT, please explain:
Are you prepared to commit to a pet for 15 - 20 years (average life span)?
*
Yes
No
Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?
*
Yes
No
If yes, please describe:
Have you ever adopted or tried to adopt a pet from us before? If yes, fill out info below.
*
Yes
No
Pet’s Information
Pet’s Name
Cat or Dog?
Adoption/Application Date
Where will your dog spend most of his/her time?
*
Please Select
Indoors Only
Outdoors Only
Indoors and Outdoors
Barn Cat
Basement/Garage
Confined
If you selected outdoor, would your dog be supervised?
Yes
No
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
*
First and Last Name & Relationship to Self
Reference # 1 Phone Number
*
-
Area Code
Phone Number
Reference #2
*
First and Last Name & Relationship to Self
Reference #2 Phone Number
*
-
Area Code
Phone Number
If there is anything else you think we should know, please note it here.
Signature
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 a pet!!
Submit Adoption Application
Submit Adoption Application
Print Form
Should be Empty: