Dog Adoption Application

Flat Rock Animal Shelter takes in owner surrendered, neglected, abandoned or stray animals, as well as those that are sometimes ordered removed by the courts.

We make every attempt to screen our animals for health, behavior and temperament issues. Certain types of problems may not demonstrate themselves until the animal is in a home environment.

For these reasons we cannot guarantee the behavior, health or temperament of any animal.
Dog you are interested in: *
First and Last Name *
Primary Phone Number *
Secondary Phone Number
Address, City, State, Zip *
Email Address *
Type of Residence *
Do you own or rent *
How long have you lived here? *
If you are renting, please provide you landlord's name and phone number
Is this the first time you have owned a dog as an adult? *
Please provide your veterinarian's name and phone number *
Please list all animals that currently live in your home or that you have owned in the last three years. Name, breed, age, and sex. If you do not own them anymore, please explain why. *
Please list all persons living in the home *
Are all the animals in your household spayed or neutered?*

YesNo
Does anyone in your house have allergies to animals? *
Does anyone in the home have a medical condition that will stop them from providing care to the animal? *
Please describe what kind of dog you are looking for (long or short hair, size, weight, male/female, age) *
Please select all the qualities that you are looking for in a dog*

Easy on a leashLap dogConfidentPlayfulEnjoys car ridesActiveProtectiveRough houserGood with other dogsIndependentGentleEnergeticGood with catsCalmDependentQuietEnjoys hiking, jogging, runningGood with childrenAdult dog that is settled
Do you plan to crop the ears or tail or debark your new dog?*

YesNo
Would your new dog have any of the following visiting:*

children under 10teenagersmale dogsfemale dogscatslivestockhorsesnone
What are some training needs that you do not wish to encounter?*

HousebreakingEscapingDiggingChewingExcessive barkingProtectiveLeash pullingJumpingStubbornFood aggressionToy aggressionShy/fearfulPlays too roughNeeds a lot of attentionOther
There are some behaviors that require patience, formal training, or prior dog experience. If your new dog does display any of these behaviors, how will you go about teaching him/her?*

Contact a professionalUse a bookGooglePersonal knowledgeOther
How would you describe your household?*

very activelots of kids visitsome activityfrequent adult visitorsquietOther
When you are home, where will your new dog be?*

Loose in the homeCrate in the homeLoose outsideTied up outsideOutside kennel/penWithin fenced yardGarageDoghouse in yardBasementOther
When you are NOT home, where will your new dog be?*

Loose in the homeCrate in the homeLoose outsideTied up outsideOutside kennel/penWithin fenced yardGarageDoghouse in yardBasementConfined to a roomRunner in yardDoggie day careOther
All dogs require exercise. How will your new dog get adequate exercise?*

Run in yardOutdoor kennel/penFenced yardDaily leash walksLoose outsideOff leash dog parkHiking/joggingMid-day dog walkerDoggie day careOther
Do you have a steady stream of income?*

YesNo
If you are employed, please indicate where you work *
There are additional expenses for pets for routine care and possible unexpected medical costs. Are you prepared to be financially responsible for you new pet?*

YesNo
It may take weeks for the new dog to adjust to a different environment. It may even require keeping the animals separate to introduce them properly. Are you prepared to handle this?*

YesNo
In a new environment it can be hard to determine if an animal is housebroken. Will you be able to tolerate accidents and train the pet?*

YesNo
Are all family members in agreement about adopting a dog?*

YesNo
Have you or any member of your household been subject to legal action for cruelty to, neglect of, or abandonment of any animal?*

YesNo
Home checks are required prior to adoption. Will you allow us to complete a home check?*

YesNo
Are there any topics that you would like to discuss with our adoption coordinator? *
I understand that purposeful falsification of the information contained in this form will result in automatic denial of an adoption, or subsequent confiscation of already adopted pet (s). I certify that the information I have provided herein is accurate and I authorize Flat Rock Animal Shelter to investigate all statements made on this questionnaire. I understand that Flat Rock Animal Shelter makes no representation or guarantee about any animal's temperament, behavior, health or any combination thereof. Flat Rock Animal Shelter is not held liable for any future injury or damage, which may be caused by any adopted animal, nor is Flat Rock Animal Shelter responsible for any illness or medical malady, which may befall the animal subsequent to adoption. Flat Rock Animal Shelter reserves the right, at our sole discretion, to refuse any applicant for any reason.*

I understandI do not understand
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