Rescue Dog Adoption Application

Marie's Rescue Dog Adoption Application
This questionnaire is designed to help Marie's Rescue and yourself determine if a specific dog is the right one for you and your household. Please be sure to answer ALL questions. Marie's Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoption.

Any dog adopted from Marie's Rescue will be spayed/neutered, up to date on Rabies and Distemper vaccines and will be microchipped. Thank you for choosing to adopt!!!
Applicant Information
Your full name:*
Name of the dog you are interested in:*
Your age:*
Street Address:*
City, State, Zip*
Home Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:
Household Information
Character reference and phone number. **If providing a Vet reference, only 2 personal references are needed.
Character reference and phone number:
Character reference and phone number:
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If 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 any pets you own or have owned in the past five years, and their ages
How many of these pets are spayed/neutered?
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. Let them know that I will be calling them otherwise they won't speak with me.
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
How many hours each day will your new pet be home alone?*
How will you supervise the dog's outdoor activity?*
Where will your new dog stay when nobody is 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
What circumstances would lead you to give up your new dog?*
Should be Empty:

Marie's Rescue Dog Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information