Adoption Application

Dog is My Shepherd Rescue & Rehabilitation Adoption Application
Dog is my Shepherd Rescue & Rehab is a 501c3 nonprofit rescue located in Illinois devoted to saving, training, and rehabbing dogs locally and nation-wide from the shelters to the streets. We rescue all breeds, all ages, all sizes, and all personalities. We don't discriminate, from pitbulls to puppies, and everything in between, we rescue them all. We are run by two dog loving gals that want to make a positive pawprint with both short term and long term goals. We know we cannot save them all, but we can save many, and it's our mission to make sure they get their happily ever after.
Applicant Information
Name of the dog/cat you are interested in:*
Your full name:*
Your age:*
Street Address:*
City, State, Zip- All must be filled or application will be rejected *
Home Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Cell Phone:*

Area CodePhone Number
E-mail:*
Employer:*
Reference and phone number:*
Household Information
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:*
Does your landlord allow dogs/cats ?

YesNo
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Do you have a fully fenced yard?*

YesNo
How many adults are in your household?*
How many children are in your household?*
If children, what are their ages?*
Have your children been around animals before?*

YesNo
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
Current/Previous Pet Information
List any pets you own or have owned in past 5 years and their breed , ages*
How many of these pets are spayed/neutered?*
Where are these animals now?
Have you adopted from an animal welfare group before?

YesNo
If yes, what group?
Have you ever given up a pet?

YesNo
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic:*
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Are you aware of crate training?*

YesNo
Have you ever house-broken a pet before?*

YesNo
If the pet has an "accident" in your home, what type of correction do you plan to use?*
How many hours each day will your new pet be home alone?*
Where will your new pet sleep at night?*
How will you supervise your pet outdoor activity?*
Where will your new pet stay when nobody is home?*
What length of time will you allow your new pet to adjust to his new home?*
Are you willing to work through your new pet's issues, if any?*

YesNo
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo
Do you understand that pet can be an 18 year commitment, and can cost $1300 - $1500 per year to care for?*

YesNo
Do you plan to take an obedience training with your pet ?*

YesNoNot sure
If yes, where?*
Are you aware that a large breed dog/ large breed cats takes about two years to mature? Is this something you're prepared for?*

YesNo
What circumstances would lead to you give up your new pet ?*
If you had to give up your pet , what would you do with him/her?*
How did you find out about Dog is my Shepherd Rescue & Rehabilitation?*

Adoptapet.comPetfinder.comFacebookFriend/Family MemberEventNext DoorOther
By signing this application, I acknowledge that if I adopt this animal, the animal is adopted AS IS, with no guarantees or warranties of any kind regarding health, medical condition, temperament, or behavior, and that upon adoption I assume full financial and legal responsibility and agree to release, indemnify, and hold harmless Dog Is My Shepherd Rescue & Rehab from any and all liability, claims, or expenses arising after adoption.
Date

MonthDayYear
Date
Signature

Powered by Jotform SignClear
Should be Empty:

Dog is My Shepherd Rescue & Rehabilitation Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information