Dog Adoption App

VSSS Rescue, Inc Adoption form
Name

First NameLast Name
Dog Adoption Application
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long at this address?:*
Are you planning on moving within the next 6 months?*

YesNo
If yes, what are your plans for your pets if you move?
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Up until what time of night can we contact you via phone?*
E-mail*
Are you 18 years of age or older?*

YesNo
Birth Date*

MonthDayYear
Do you own your own home?*

YesNo
If no, name and phone # of landlord:
Type of Dwelling:*
Name and age of ALL occupants in household (including yourself):*
If no children, do you plan on having children or will children be visiting the household frequently?*

YesNo
What is your reason for wanting to adopt a dog?*

HousepetCompanionCompanion for petGiftGuard DogOther
If other, please explain:
How many total hours will your new pet be left alone during the day?*
How many total hours will your new dog be outside alone during the day?*
If adopting a puppy, where would the puppy be kept when alone?
Do you have a fenced yard?*

YesNo
If yes, which type of fence?*

WoodChain LinkSplit RailN/A
If yes, how tall is your fence?:*
Do you have locks and/or latches on all your gates?*

YesNoN/A
Will your adopted dog or do your current dogs be put on a tie out?*

YesNoNot sure
Are any members of your household allergic to animals?*

YesNo
If yes, please describe:
Over the past 5 years, how many pets have you owned? (Include current pets)*
Have you and your spouse (if applicable) ever owned a pet together?*

YesNoN/A
If yes, when?
Have you ever lost or given away a pet?*

YesNo
If you currently own a dog or cat, how does he/she react to new pets?
Are your present pets up-to-date on their annual vaccines?*

YesNoN/A
If no, please explain:
Are your present pets spayed or neutered?*

YesNoN/A
If no, please explain.
Were your previous pets spayed or neutered?*

YesNoN/A
If no, please explain.
How much are you financially prepared to spend for routine/emergency medical care, licensing, etc?*
What plans do you have for your new pet when you are on vacation?*
Which dog(s) are you interested in?*
Age of dog you would consider adopting: (check all that apply)*

PuppyYoungAdultSpecial NeedsSeniorBonded Pair
Can/Will you provide your dog with monthly heart worm/flea/tick prevention?*

YesNo
Who is your current or most recent veterinarian? Please provide their NAME and PHONE NUMBER:*
If your dog displays behavioral problems (such as jumping on people,excessive barking, potty accidents, etc.) how would you go about correcting the behavior?*

Contact a ProfessionalUse a bookPersonal KnowledgeOther
If other, please explain:
What type of solution would you be willing to try if housebreaking accidents continue after the first week (check all that apply)?*

Try crate trainingUse positive enforcementUse potty padsHave dog examined by vetUse a dog doorReturn dogNoneOther
If other, please explain:
Is your entire immediate family in agreement with the decision to bring a new pet into your home?*

YesNo
If anyone is NOT, please explain:
Are you prepared to commit to a pet for 15 - 20 years (average life span)?*

YesNo
Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?*

YesNo
If yes, please describe:
Have you ever adopted or tried to adopt a pet from us before? If yes, fill out info below.*

YesNo
Pet’s Information

Pet’s NameCat or Dog?Adoption/Application Date
Where will your dog spend most of his/her time?*
If you selected outdoor, would your dog be supervised?

YesNo
Where will your dog eat?*
Where will your dog sleep?*
If there is anything else you think we should know, please note it here.
Please remember, it may take approximately 2 to 3 business days for us to get back to you.
Thank you so much for wanting to rescue a dog!!
Should be Empty:

VSSS Rescue, Inc Adoption form

Dog Adoption Application

Please remember, it may take approximately 2 to 3 business days for us to get back to you.

Thank you so much for wanting to rescue a dog!!