Dog Adoption App

Dog Adoption Application
Please note, we now consider adoptions in NY, PA & CT, within a 2 hours radius of Bergen County, NJ. Please advise your location below
How did you hear about our rescue ?*
Name of the dog you want to adopt*
If your preferred dog is not available, would you be open to adopting another dog?*
Adopters Name*

First NameLast Name
Co-Adopters Name*

First NameLast Name
Adopters Email*
Co-Adopters Email*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long at this address?:*
Are you planning on moving within the next 6 months?*

YesNo
If yes, what are your plans for your pets if you move?
Home Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Name of Employer (if self employed, name of the business):*
Co- Adopters Name of Employer (if self employed, name of the business):*
Occupation :*
Co- Adopters Occupation :*
Work Phone Number*

Area CodePhone Number
Co- Adopters Work Phone Number*

Area CodePhone Number
Up until what time of night can we contact you via phone?*
Facebook Username*
Co- Adopters Facebook Username*
Instagram Username*
Co- Adopters Instagram Username*
Are you 18 years of age or older?*

YesNo
Birth Date*

MonthDayYear
Type of Dwelling:*
Do you own your own home?*

YesNo
If no, name and phone # of landlord:*
If you live in an Association, please give the name and number to confirm no breed/weight restrictions:*
Are you able to provide a copy of your lease showing pets are allowed or an email from your landlord ?*

YesNoN/A
If No please explain:
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?*

YesNo
What is your reason for wanting to adopt a dog?*

HousepetCompanionCompanion for petGiftGuard DogOther
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 any dog behavior issue experience ?*

YesNo
If Yes, please explain
Are you comfortable adopting a dog with behavior issue ? ex. fearful with people, separation anxiety etc.*

YesNo
Are you comfortable adopting a dog that is not dog friendly etc..*

YesNo
Do you have a fenced yard?*

YesNo
If yes, which type of fence?*

WoodChain LinkSplit RailN/A
If yes, how tall is your fence?:
Do you have locks and/or latches on all your gates?*

YesNoN/A
Will your adopted dog or do your current dogs be put on a tie out, outside?*

YesNoNot sure
Dogs must be supervised at all times while outdoors. If you do not have a fenced yard do you agree to keep your dog on leash at all times when outside?*

YesNo
Are you or any members of your household allergic to animals?*

YesNo
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 List any Pets you have Living or Deceased - (please include BREED, AGE, SEX)*
Are your present pets up-to-date on their annual vaccines?*

YesNoN/A
If no, please explain:
Are your present pets spayed or neutered?*

YesNoN/A
If no, please explain.
Were your previous pets spayed or neutered?*

YesNoN/A
If no, please explain.
Were your previous pets up-to-date on their annual vaccines?*

YesNoN/A
If no, please explain.
If you currently own a dog or cat, how does he/she react to new pets?*
Have you and your spouse (if applicable) ever owned a pet together?*

YesNoN/A
If yes, when?
Have you ever lost or returned a dog from adoption or foster ?*

YesNo
If YES please explain:
Do any other pets or people ever visit your home?*

YesNo
If YES 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?*
Can/Will you provide your dog with monthly heart worm/flea/tick prevention?*

YesNo
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 the Rescue for HelpContact a ProfessionalPersonal KnowledgeOther
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 trainingBalanced TrainingUse positive enforcementUse potty padsHave dog examined by vetUse a dog doorReturn dogNoneOther
Are you comfortable using a prong collar if taught properly ?*
If No, please explain:*
Is your entire immediate family in agreement with the decision to bring a new pet into your home?*

YesNo
If anyone is NOT, please explain:
Are you prepared to commit to a pet for 15 - 20 years (average life span)?*

YesNo
Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?*

YesNo
If yes, please describe:
Have you ever adopted or tried to adopt a pet from us before? If yes, fill out info below.*

YesNo
Pet’s Information

Pet’s NameCat or Dog?Adoption/Application Date
Where will your dog spend most of his/her time?*
If you selected outdoor, would your dog be supervised?

YesNo
Where will your dog eat?*
Where will your dog sleep?*
Please provide 2 personal references (CANNOT BE FAMILY MEMBER, SPOUSE or PARTNER) that can testify to your responsibility and ability to care for your animals. This is required or your application will not be approved.
Reference #1 (cannot be a family member, spouse or partner)*
First and Last Name & Relationship to Self
Reference # 1 Phone Number*

Area CodePhone Number
Reference #2 (cannot be a family member, spouse or partner)*
First and Last Name & Relationship to Self
Reference #2 Phone Number*

Area CodePhone 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!!
Upload Drivers License*

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Dog Adoption Application

Please provide 2 personal references (CANNOT BE FAMILY MEMBER, SPOUSE or PARTNER) that can testify to your responsibility and ability to care for your animals. This is required or your application will not be approved.

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!!