A PLACE OF HOPE SMALL DOG RESCUE ADOPTION APPLICATION
Fill out all information completely and accurately to avoid delays in processing. Remember to check your spam for questions or responses from our review team! Submission of an application does not guarantee approval or obligate you to adopt. To follow up on your application, email christineapoh@gmail.com.
Today's date
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Month
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Day
Year
Date
Please tell us the dog's name, age, and breed that you are interested in or Pre-Approval if seeking a pre-approval review.
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What are you looking for in a pet?
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How quickly are you looking to adopt? *We are a foster based rescue and cannot hold dogs. Meets are typically set within a week of application approval.
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Adopter's Name
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First Name
Last Name
Adopter's Age
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Spouse / Partners Name or not applicable if this does not apply to you.
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First Name
Last Name
Spouse/Partners Age or 0 if this does not apply to you.
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email (please check for accuracy prior to submission)
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example@example.com
What type of housing do you live in?
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Single family home
Condo/ Townhome/ Apartment
Duplex
Live with someone else
Rent
Landlord or Home Owner Name
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First Name
Last Name
Landlord's Phone Number or all 0's if this does not apply to you
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Please enter a valid phone number.
Do you have children that live in your home?
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Yes
No
If yes, please describe their typical interaction with dogs or NA if no:
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Please tell us the full names and ages of adults and children who live in the home (other than yourself and your spouse/partner):
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Do you have children that visit your home?
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Yes
No
If yes, how old are the children that visit your home? (0 if this does not apply to you)
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Do you have a fenced yard?
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Yes
No
Partial
Please tell us about your fenced yard:
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No fence
4-5 ft chain link
6 ft chain link
Picket
4-5 ft privacy
6 ft privacy
Wrought iron
Partial fence
If partial, please explain or NA if this does not apply to you.
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Do you have an in-ground pool?
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Yes
No
Is it enclosed or fenced off so that there is no pet access?
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Yes
No
NA - no pool
Do you use a dog door?
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Yes
No
How many dogs do you currently have?
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Please list the name, age, breed and weight of each dog or NA if this does not apply to you
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Number of cats?
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Number of any other pets
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List all Veterinarians or Clinics that you use for your pets or NA if this does not apply to you.
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Veterinarians Phone #s or all 0s if this does not apply to you.
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Please enter a valid phone number.
What name will the vet have the records under? (Use Not Applicable if it does not apply to you)
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First Name
Last Name
Are all of your animals spayed/neutered?
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YES
NO
Are they up to date on their Rabies vaccine?
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YES
NO
Are they up to date on their DHPPV vaccine?
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YES
NO
Are they tested annually for Heartworms?
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YES
NO
Are they on Heartworm prevention?
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YES
NO
If yes, what brand and where do you purchase it?
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If no to spaying/neutering, up to date on shots, heartworm testing and prevention, please explain or NA if this does not apply
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Are they on Flea prevention?
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YES
NO
Will your dog welcome a small dog? (NA if you don't have any dogs.)
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YES
NO
NA
Where will your dog stay?
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Inside
Outside
Inside and outside with a dog door
Where will your dog stay when you are not at home?
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How many hours a day total will your dog be home alone?
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Will your dog be crated?
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YES
NO
If yes to crating, how many hours during the day? (0 if this does not apply)
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If yes to crating, how many hours at night? (0 if this does not apply)
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Where will your dog sleep at night? (crate, dog bed, in bed with owner, other)
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IF YOU CURRENTLY HAVE NO PETS
PLEASE FILL OUT THE NEXT 5 QUESTIONS
Have you owned a pet(s) in the past 10 years that is not listed above?
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YES
NO
If yes, what was your previous pets name and what type of pet? If no, put NA.
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What happened to this pet(s)? Select NA if there are no prior pets.
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Passed away due to illness
Passed away due to injury
Passed away due to old age
Rehomed
NA
If your prior pet(s) passed away due to illness or injury, please explain in more detail or put NA if this does not apply to you.
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Previous pets Veterinarian or Clinic Name or NA if there are no prior pets
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Previous pets Veterinarian's Phone # or all 0's if there are no prior pets
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Please enter a valid phone number.
What name will the previous pets vet have the records under?
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First Name
Last Name
SINCE YOU ARE APPLYING TO ADOPT ONE OF OUR DOGS YOU AGREE TO THE FOLLOWING TERMS BY SELECTING YES:
PLEASE READ THESE
YOU AGREE TO ALLOW AN APOH VOLUNTEER TO CONTACT YOUR CURRENT AND PREVIOUS VETERNARIAN TO DO A VET REFERENCE. THEY WILL BE VERIFYING THE CARE THAT YOU HAVE PROVIDED FOR YOUR CURRENT AND PAST PETS. IF THE VET REFERENCE DOES NOT MEET OUR STANDARDS OF CARE, THE APPLICATION WILL BE DENIED.
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YES
NO
IF YOU FEEL THAT THE VET HAS GIVEN US INCORRECT INFORMATION, IT IS YOUR RESPONSIBILITY TO CONTACT YOUR VET AND GET THE INFORMATION CORRECTED AND LET US KNOW SO WE CAN REPEAT THE PROCESS.
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YES
NO
YOU AGREE TO A HOME VISIT DONE BY ONE OF OUR VOLUNTEERS EITHER BEFORE OR AFTER THE ADOPTION. A NEGATIVE HOME VISIT WILL NULL AND VOID THE ADOPTION CONTRACT. IF THE HOME IS NOT FOUND TO BE A SAFE AND HEALTHY ENVIROMENT FOR THE DOG YOU AGREE TO LET THE VOLUNTEER CONDUCTING THE HOME VISIT TAKE THE DOG AND RETURN IT TO APOH RESCUE AT THAT TIME. IF IT IS DETERMINED THAT THE DOG NEEDS TO BE RETURNED TO THE RESCUE A FULL REFUND OF THE ADOPTION FEE WILL BE ISSUED BY CHECK WITHIN 10 BUSINESS DAYS.
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YES
NO
IF YOU ARE ADOPTING A DOG THAT IS WAITING FOR A SPAY/NEUTER: IT IS REQUIRED THAT YOU GET YOUR NEW FAMILY MEMBER TO THE APPOINTMENT THAT IS PROVIDED TO YOU. IF YOU ARE UNABLE TO MAKE IT TO THE APPOINTMENT YOU MUST GIVE AT LEAST 48 HOURS NOTICE FOR US TO RESCHEDULE YOUR APPOINTMENT. CALL OR TEXT 850-503-0469 TO NOTIFY US. TEXT MESSAGE IS PREFERRED BUT IF YOU CAN NOT TEXT PLEASE LEAVE A VOICE MAIL. A MISSED APPOINTMENT WITHOUT NOTICE FORFEITS THE RESCUE PAYING FOR THE SPAY/NEUTER. THEN THE SPAY/NEUTER WILL BE AT THE ADOPTERS EXPENSE AND IS REQUIRED WITHIN ONE MONTH OF THE ORIGINAL DATE OF YOUR MISSED APPOINTMENT OR YOU AGREE TO RETURN THE DOG TO THE RESCUE.
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YES
NO
You agree NEVER to rehome the dog, and to return him/her to APOH Rescue if for any reason, or at any time you are unable to keep him/ her. Due to this requirement the microchip will always have the APOH Rescue as the primary owner. You will be listed as the adopter.
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YES
NO
If adopting an unaltered puppy, the adopter agrees to have the pet spayed/neutered by 6 months of age by our vet. Failure to have the spay/ neuter done by 7 months of age will result in forfeiture of the pet. The pet will be returned to APOH Rescue. No refund will be given if the pet is returned to APOH Rescue due to failure to adhere to the spay/neuter policy.
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YES
NO
Pet will be altered at one of our veterinarian's offices at APOH Rescue's expense . If you chose to have the pet altered at your vet, you agree that it is at your own expense.
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YES
NO
If your new dog shows signs of illness in the first 3 days please text or call 850-503-0469. If it is something that requires a vet visit, we will make you an appointment at our vet and we will cover the cost. If you take the dog to your personal vet we will not be responsible for the vet bill.
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YES
NO
You understand that there is a fee to adopt a dog. The fee covers the vet care and is what helps the Rescue to continue to save dogs. This includes all vaccinations (Rabies, DHPPV and Bordetella), a fecal, a microchip with a lifetime registration, Proheart 12 Injection for a full years heartworm protection (if one year or older), all dogs over 6 months of age have been tested and are heartworm negative OR if Heartworm positive they are being treated by APOH Rescue until they are heartworm negative, spay/neuter, dentals if medically necessary and any health issues that the dog needs to be treated for.
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YES
NO
You agree to continue to provide necessary vet care for your pet's lifetime?
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YES
NO
The pet will be microchipped with a lifetime registration that is covered by APOH. The microchip is non-transferrable and will stay with APOH as the primary contact. You will be listed as the "adopter" and need to keep your contact information current with APOH if something changes.
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YES
NO
If for any reason you are not satisfied with your rescue dog, the adoption fee is refundable minus a $50 fee, if returned within the first 10 days. If you would like to try a different dog there is no fee, but you will be required to pay any difference in the adoption fee.
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YES
NO
The adoption fee is non-refundable after the 10 day adjustment period.
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YES
NO
If a refund is being issued: A check will be issued to you within 10 business days of the date of the return of the dog.
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YES
NO
The adoption fee may be paid by cash, local checks with valid ID, PayPal, Venmo, credit card (a 3.5% fee is added for credit card payment) or money order.
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YES
NO
Adoption fees average $300 to $500 and can vary. Each dog may have a different fee. These fees are subject to change without notice. This fee is set by the board and is what helps the rescue save your rescue dog and many more rescue dogs in the future.
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YES
NO
We only adopt to owners we feel are suitable. Our adoptions will always be age appropriate adoptions. Small breed dogs cannot live outdoors or be left alone for long periods of time. They may require dental exams yearly along with regular physical exams. If you are approved for adoption, you agree that all veterinary care will be provided as recommended by your veterinarian.
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YES
NO
Your signature means that you agree to the terms in this Adoption Contract. Adopter's signature
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Submit
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