Adoption Application
All dogs will have age appropriate medical care, spay/neutered, and microchipped.
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
*
example@example.com
Are you 18 years of age or older?
*
Yes
No
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 dog be left alone during the day?
*
How many total hours will your 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 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 dog?
*
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.
What plans do you have for your new dog when you are on vacation?
*
Which dog(s) are you interested in?
*
Age of dog you would consider adopting: (check all that apply)
*
Puppy
Young
Adult
Special Needs
Senior
Bonded Pair
Can/Will you provide your dog with monthly heart worm/flea/tick prevention?
*
Yes
No
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:
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:
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 stated 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) and the name of your veterinarian 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
Veterinarian
*
Veterinarian Phone Number
*
-
Area Code
Phone Number
If there is anything else you think we should know, please note it here.
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 dog!!
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