Rescue Dog Adoption Application

Roams to Homes Adoption Application
Roams to Homes (R2H) is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. R2H is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive medical care and are up-to-date on vaccines. R2H makes no guarantees or statements regarding the dog's age, breed, health, or temperament. While R2H made every effort to provide accurate history and assessment of the dog, we are not able to guarantee the dog’s age, breed, medical status, behavior or disposition.
This application is designed to help R2H and yourself determine if a specific dog is the right fit for you and your household. All adopting parties are required to complete this form prior to adoption. R2H reserves the right to deny any application.
Applicant Information
Name of the dog(s) you are interested in:*
Your full name:*
Date of Birth:*
Date of Birth:*

MonthDayYear
Date
Street Address:*
City, State, Zip*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:

Area CodePhone Number
Cell Phone:*

Area CodePhone Number
E-mail:*
Employer:*
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 (Homeowner note n/a.):*
Does your landlord allow dogs?

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
Height and type of fence
List all members of your household by legal name and current age. Please include yourself.*
If you have children in your household, explain their experience with dogs.*
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
If yes, explain
Explain the activity level in your home.*
What is your work schedule? Will someone be home during the day?*
Current/Previous Pet Information
List any pets you own or have owned in the past five years, please include ages and species (i.e. cat, dog, etc.) for each pet.*
Are/were the pets 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 comfortable with crate training, if needed?*

YesNo
Have you ever house-broken a dog or puppy before?*

YesNo
If the dog 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 the dog's outdoor activity and are you willing to leash train?*
Where will your new dog 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 a dog can be an 18 year commitment?*

YesNo
Do you plan to take an obedience class with your dog?*

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

YesNo
What circumstances would lead you to give up your new dog?*
If you had to give up your dog, what would you do with him/her?*
How did you find out about R2H?*

Adoptapet.comPetfinder.comFacebookFriend/Family MemberOther websitePetSmartOther
References

Please list three references include name, phone number and relationship. **At least two references should NOT be family members.
Reference #1
Reference #2
Reference #3
Other Considerations
Do you agree to have dog seen by a licensed veterinarian within 14 days of bringing the dog home? I understand that I assume full responsibility for the welfare of this pet from the date of adoption.*

AgreeDisagree
If this is a long distance adoption, and you are unable to keep your dog, are you willing to assume the responsibility, including travel, boarding and financial responsibility, for returning the dog to R2H?*

AgreeDisagree
If your dog is not spayed/neutered at time of adoption, do you agree to spay/neuter your dog within six months of the adoption date?*

AgreeDisagree
I give R2H representatives permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I understand a home and yard visit by a R2H's representative is required prior to finalizing this application.*

AgreeDisagree
I certify that, to the best of my knowledge, the provided information is true and accurate.*

AgreeDisagree
Signature*

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Roams to Homes Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information

References

Other Considerations