Application to Adopt a Dog
Tell Us About Yourself
Name
*
First Name
Last Name
Date of Birth
*
Cell Phone Number
*
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
Are you able to receive text messages?
*
Yes
No
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Spouse/Partner/Roommate
First Name
Last Name
Age of Spouse/Partner/Roommate
Phone Number
Please enter a valid phone number.
Do you rent or own your home?
*
Own
Rent
Name of Landlord:
First Name
Last Name
Phone Number of Landlord:
-
Area Code
Phone Number
Why are you adopting a dog?
*
Name of dog/s you are interested in?
*
Do you have a fenced yard?
*
Yes
No
If YES, what type of fencing do you have and how tall is it?
*
Type of dog you are interested in (click all that apply)?
*
Puppy
Young
Adult
Senior
Doesn't Matter
Gender:
*
Male
Female
Doesn't Matter
Fur Preference:
*
Short Hair
Long Hair
Doesn't Matter
Energy Level:
*
Low Energy (quiet and calm)
Moderate Energy (enjoys a nice walk and a little play time but will chill out the rest of the day)
High Energy (very active and playful - needs long walks and playtime)
Doesn't Matter
Are all members of the household in agreement to adopt a dog?
*
Yes
No
Has not yet been discussed
Please describe your experience with dogs:
*
Please list names and ages of all people living in the home:
*
Who will be the dog's primary caregiver?
*
Please list names, ages, and breeds of all animals living in the home:
*
Tell us about your family life and activity level:
*
Is anyone home during the day?
*
Yes
No
If YES, who?
If NO, how many hours a day will the animal be left alone?
*
How often do you travel and who cares for your animals while you are away?
*
Please describe what type of exercise and enrichment you will provide for your dog:
*
Does anyone living in your home have asthma or allergies to animals and if YES, how are they managed?
*
Under what circumstances would you choose to return your pet?
*
Are you willing to have an initial in-home visit or follow-up visit if deemed necessary by Passion 4 Paws?
*
Yes
No
Are you willing and financially able to accept full and immediate responsibility for the ownership of this cat/s, including annual and emergency healthcare costs, food, litter and other responsibilities of pet ownership?
*
Yes
No
Are you willing to seek and begin immediate training if mandated by the rescue and/or if behavioral issues arise after taking ownership of this pet?
Yes
No
If NO, why not?
If you are unable to keep this pet, do you agree to return it to Passion 4 Paws?
*
Yes
No
References
Personal Reference 1
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship to you
*
Personal Reference 2
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Relationship to you
*
Name of Current Vet
*
Phone Number
-
Area Code
Phone Number
Name on the Account
Names and Numbers of Previous Vets
*
How did you hear about Passion 4 Paws?
*
Do you affirm that all information in this application is true?
*
Yes
No
Submit
Should be Empty: