Texoma Dog Ranch Rescue Adoption Application

Adoption Application Texoma Dog Ranch Rescue, 501-3c

278 FM 1753, Denison, Texas 75021

Submit to: Texomadogcoordinator@gmail.com

1. Name (Adopter)

2. Dog interested in. If you do not have an interest in a specific dog please leave blank.

3. Please provide two forms of communication.

Home phone

Work phone

Email

example@example.com

Employer or Occupation

Veterinarian reference

Address

Clinic address

Street Address Line 2

Zip

Reference Name

Phone number

Reference Name

Phone number

Your Address

Home address

Street Address Line 2

Zip

Rent or own

If you rent please provide info below.

Community or Landlord's name

Phone number

Ex. Apartment, townhome, house, etc.

Fenced yard: yes or no (circle one) If you have a yard please provide information below.

no

Size of yard

Fence height

Fence style

Outside kennel: yes or no (Circle one) If you have one please provide information below.

Size

Season used in

Enclosed: yes or no (Circle one)

Number of other adults in household

*Please include frequently visiting friends*

Gender and ages

Number of children in household at any time

Gender and ages

Number of other pets in household

Pet types

Gender, age, and breed of pets

11. Primary caregiver of this dog

12.How will this dog be exercised

Ex. Daily walk, weekly jog, etc

13.Where will the dog stay at night

14.Where will the dog stay during the day

15. How many hours a day will your dog be alone

16. Will you use a tie-out, cable, or chain to restrain your dog outside: yes or no (circle one)

17. Is there an adult home during the day: yes or no (circle one)

18. Do you plan to take this dog to obedience training: yes or no (circle one) *Please be 100% honest*

Car make, model, and year

Where will your dog ride

Will you make frequent breaks for your dog: yes or no (circle one)

20. Who will look after your dog while you are away? Ex. Vacation, business trip, emergency, etc.

Do you participate in outdoor or public activities that your dog will be attending? If yes please provide information below.

Activity type(s)

How often do you plan for your dog to take part

Will you allow your dog time to transition into the new lifestyle: yes or no (circle one)

* *Dogs can take two weeks to months to get accustomed to new habits. Please be patient with your pet*

Level of dog experience

Do you have experience with rescue dogs: yes or no (circle one)

If yes please provide information below. Short description:

Short description

23. Preferences and expectations - if applicable

Preferred gender

Preferred age range

Preferred activity level

Ex. Couch potato, occasional walks, 10 k runner, etc.

Desirable qualities

Ex. Excellent vocals, best at hide and seek, etc.

Absolute deal breakers

24. Other questions - if applicable

Would a dog that needs a daily dose of medication be a special needs dog: yes or no (circle one)

Would you be okay with a special needs dog

Would you be okay with a special needs dog: yes or no (circle one)

Do you feel financially comfortable with a special needs dog: yes or no (circle one)

Under what circumstances would you consider surrendering your dog?

Short explanation

When do you plan to adopt

Ex. Now, Later, specified date, etc.

25. Do you agree to an at home environment check: Yes or No (Circle one)

If no, please give a brief explanation why

A rescue dog MAY have experienced an unfortunate history of one or more of the following: neglect, abuse, abandonment, loneliness, insecurity, distrust. A period of adjustment (days for some up to months for others) should be expected in some instances. Often, the new dog is so grateful and overwhelmed with your show of love, devotion and consistency that she/he relaxes immediately and opens her/his heart to you. In either case, a rescue dog is almost always grateful, loyal, very affectionate, eager to please and very companionable.

Submission of your application does not guarantee placement of a dog. Applicants must agree to a home visit. Also, the first week is considered a trial period to make sure that the dog and adopter are compatible in the adopter's home setting. And the end of the first week, the adoption maybe finalized if

there are no outstanding issues.

I understand that any misrepresentation of fact may result in the removal of the placed dog from my home. I understand that Texoma Dog Ranch Rescue, 501-3c is not responsible for the accuracy of information received about the temperament habits or physical condition of dogs available for adoption, nor is liable or responsible for any damage, injury or accident resulting from the placement of this dog.

I will fully accept the responsibilities for the health, housing, feeding, any training needed and the wonderful companionship of this dog. Also, if for any reason the adopted dog is not an appropriate fit for your household, please notify us immediately. We will work with you to address any issues or take

him back to assure his safety.

Guardian's signature

Date

Date of placement

Date

Dog's name

Dog's physical description

Any belongings sent with the dog