510 Paws Adoption Application Form
Completion of this application does not guarantee adoption of pet.
Name of the pet you are applying for
*
Applicant Details
Name
*
First Name
Last Name
Adopters Age
*
Occupation
*
Co Applicant Name
First Name
Last Name
Co Applicant Age
Occupation
Ages of the other family members in the home. Write n/a if it does not apply
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (Mobile)
*
Phone Number (Work)
*
Phone Number (Home)
*
E-mail
*
example@example.com
I / We live in a
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Single Family Home
Duplex / Twin
Condo / Townhome
Trailer
Apartment
Other
Do you own or rent?
*
If renting, do you have permission from landlord to have a dog?
Landlords name and phone number
Do you have a fenced in yard?
*
Yes
No
How high is your fence?
*
Have you recently inspected your fence and is it secure, without holes, gaps, or low points? If NO, and your application is accepted, do you agree to thoroughly inspect your fence and make any necessary repairs before the home visit?
*
Type of fencing?
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Chain Link
Wood
Block/ brick wall
Other
Is there any type of lock on the gate[s]?
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Padlock
Key
Latch
Other
Do you have a pool? If yes, is there a secure fence around it?
Who has access to your yard?
*
Gardener
Pool Technician
Housekeept
Utility
Neighbor
Other
Do you have another pet?
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Yes
No
Is your pet comfortable with dogs?
Yes
No
Other
Where does the pet stay (be confined) while you are out?
*
How do you discipline your pets and why? (describe)
*
What are your primary reasons for wanting a dog?
*
Companion
For my children
Gift
For other pet
Watchdog
Other
If you have children, please describe their previous experience with dogs:
*
If your children did not want a dog, would you be interested in adopting a dog for yourself?
*
Yes
No
Does anyone in your household have allergies?
*
Yes
No
Please list all the current pets in the home and their species (dog, cat, bird, reptile, etc.), sex & age of each pet:
*
Are your pets spayed/neutered
*
Yes
No
Have you ever allowed an animal to breed?
*
Yes
No
Is there anybody at home during the day?
*
Yes
No
Number of hours (average) pet(s) spends alone
*
Where will your pet be when left alone?
*
Where will the dog sleep at night?
*
What rooms are off limits to the dog?
*
What outside areas are available to the dog?
*
Do you have a doggie door?
*
Yes
No
When you go on vacation, who will care for the dog?
*
Preferred level of exercise with dog?
*
Couch Potato
Short Walks
Vigorous Walks
Hiking
Running
Other
Would your dog wear a collar?
*
Yes
No
Would you allow your dog to wear a permanent RESCUE I.D. tag?
*
Yes
No
How would you rate your level of dog owning experience?
*
1st Time Dog Owner
Beginner
Intermediate
Advanced
Expert
How would you train this dog?
*
Obedience Classes
Hit with newspaper
Firm verbal command
Clicker/hand signals
Other
How do you normally walk you dog?
*
On leash
Off leash
When on leash I normally use:
*
Collar
Choke chain
Prong collar
Gentle Leader
Harness
Other
What kind of food will you feed the dog? Brand of Kibble Name:
*
If applying for a dog with hair do you understand that they require haircuts every 4-8 weeks
*
Yes
No
Who will groom and bathe your dog?
Are you willing to live with hair on the furniture, stains on your rugs, a warm body on your bed, and an animal that might be destructive at times?
*
Yes
No
Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter and exercise for your new pet?
*
Yes
No
Are you able to make a long-term commitment to care for your pet for it’s entire life span, which could be as much as 10-20 years?
*
Yes
No
Will you agree to consult and pay for a trainer or behaviorist if any problems develop?
*
Yes
No
What would happen to your pets if you moved locally?
*
What would happen to your pets if you moved out of state?
*
What would happen to your pets if you moved out of country?
*
Have you ever given a pet away? If so, please explain?
*
If something were to happen to you where you could no longer care for this dog do you have anyone (friends, family) who would be able to take him/her into their home? If so please explain:
*
Which of the following reasons might prompt you to give up your dog?
*
Excessive barking
Biting
Digging
Moving
Divorce
Poor Watchdog
Financial Problems
Shedding
Destructive chewing
Accidents indoors
Growling at guests
Being shy
Excessive vet bills
Allergies
Aggressive on leash
New spouse/partner doesn’t like dog
None of the above
Other
Please list pets you have owned since you have been an adult (Animal name, length of ownership, what happened to the pet)
*
How did you find out about our adoption program?
*
Why are you interested in adopting from a rescue?
*
Do you have a regular veterinarian?
*
Yes
No
Veterinarian’s name
*
Clinic Name
*
Clinic's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Clinic's Telephone
*
I understand that a home visit is required prior to final placement (Please type your initials)
*
I agree to provide my own collar, leash, no slip collar or harness, and personal id tag at the time of completing the adoption contract. (Please type your initials)
*
510 Paws Rescue reserves the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract. (Please type your initials)
*
*
I confirm that all information supplied above is correct and accurate.
By typing my name I acknowledge I am signing all the information above is correct and accurate.
First Name
Last Name
Submit
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