Adoption Application Form
Applicant Details
Name
*
First Name
Last Name
Age
*
Pronouns
Please Select
She/Her
He/Him
They/Them
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (Mobile)
*
-
Area Code
Phone Number
Phone Number (Work)
*
-
Area Code
Phone Number
E-mail
*
example@example.com
I / We live in a
*
Single Family Home
Duplex / Twin
Condo / Townhome
Trailer
Apartment
Other
Do you own, or rent your home?
*
Own
Rent
Other
Do you have a fenced in yard?
*
Yes
No
How high is your fence?
*
If you rent, does your building allow dogs - skip if not applicable.
YES
NO
Does your residence have a HOA?
*
YES
NO
If you rent please provide the name & phone number of your landlord or property manager.
Would you allow us to visit your home prior to adoption approval?
*
YES
NO
Adoption Details
Which dog are you applying for?
*
Why did this dog catch your attention? Are there any other dogs you are interested in?
*
Why do you want to adopt a dog?
*
Companionship
Buddy for my current pet
Gift for a friend
Emotional Support Animal
Hiking/Camping buddy
I want to rescue a dog
Other
Do you have a regular veterinarian?
*
Yes
No
Veterinarian’s name
*
Clinic Name
*
Clinic's Telephone
*
-
Area Code
Phone Number
Can we contact your veterinarian as a reference?
*
YES
NO
Number of hours (average) your dog would spend alone
*
Do you have children in the home, or children who visit the home often
*
YES
NO
Are you expecting a child in the near future?
*
YES
NO
Please list all members of your household, including: Name, Age, Gender
*
Is anybody in your household allergic to dogs?
*
YES
NO
Do you have other animals in the home?
*
YES
NO
If yes, please list the name, age, species & sex of ALL other animals.
Are all other dogs & cats in your home spayed/neutered?
*
YES
NO
If no, please explain
Have you previously owned a dog before, as an adult?
*
YES
NO
If yes, please list past dogs you have previously owned. Please include breed, age acquired, cause of death and any special notes about that dog's behavior or history.
Have you previously worked with a dog trainer, or completed a training program in the past?
*
YES
NO
What is your preferred method of dog training?
Have you ever used any training tools for a dog in your care? Please check all that you have experienced.
*
Slip Lead
Martingale Collar
Prong Collar
E-Collar
Bark Collar
Gentle Leader
Long Line
Harness
None of these
Other
Have you ever had to surrender, or relinquish ownership of a pet?
*
YES
NO
If yes, please explain.
For what reason would you return a dog to us?
*
Lost Interest
Moving
Divorce
Allergies
Medical Issues for Dog
Medical Issues for Human
Not getting along with other pet(s)
Shedding/Coat Care
Too much work
Behavioral Problems
New baby
Reactivity
Other
What activities would you like to participate in, with the dog?
*
How do you plan to exercise the dog?
*
What do you plan to do with the dog during the day?
*
When you travel, where will the dog stay?
*
Where will the dog sleep?
*
Will you crate train the dog?
*
YES
NO
What kind of temperament are you expecting from this dog?
*
What scenarios have you previously/are you confident handling?
*
Dog Introductions
Cat Introductions
Dog Aggression
Human Aggression
Cat Reactivity
Excessive Barking
Resource Guarding
Reactivity
Barrier Aggression
Basic Obedience Skills
Mouthiness
Advanced Medical Needs
Administering Medication
None of These
If yes to any of the above, please explain.
If you run into any of the unchecked issues, how would you address it?
How many hours per week can you work on training the dog?
*
Who else would be working with/training the dog, besides you?
*
What makes you an ideal person, to adopt a rescue dog?
*
References
No family members or partners
Reference #1
*
First Name
Last Name
Reference #1 Phone Number
*
-
Area Code
Phone Number
Reference #1 email
*
example@example.com
Reference #2
*
First Name
Last Name
Reference #2 Phone Number
*
-
Area Code
Phone Number
Reference #2 email
*
example@example.com
If you have any other notes please write here!
I certify by my digital signature, that all information this form is true.
*
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