Summit Dog Rescue Adoption Application

Applicant's General Information
Full Name of Applicant*
Occupation:*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Co-Applicant (Spouse, significant other, roommate):
Personal Email:
Occupation/Employer

Please list all pets in your household. Include both current AND past. *

	Species & Breed	Age	Gender	Spay/ Neuter?	Temperament	Residing with you?
.
.
.
.

For any pet no longer residing with you, please tell us why the pet is no longer in your home:*

Please list all the people in your household. *

	Name	Age
Self
Person #2
Person #3
Person #4
Person #5

Is everyone in the household on board with adopting a new dog? Please note each person’s level of commitment to the new dog using the following 1-to-5 scale: 0 indicates “don’t want a new dog in the house,” 1 indicates “I will be ok with having a new dog in the house but do not intend to be responsible for his/her care”; 5 indicates “I am excited about adding a new dog to the home and look forward to being responsible for his happiness, training, and wellbeing.”

	1	2	3	4	5
Self
Person #2
Person #3
Person #4
Person #5

Do you have your heart set on one specific CoDa Canine dog? If so, who is that? It helps us to know whether you are only applying for a particular dog or are flexible in your options.

Your Environment
Please describe your residence & environment:
Urban, suburban, or rural?*
Do you own or rent? Is this house, condo or apartment?*
If rent, include property owner's name, phone number, address, and email.
How long have you resided at this location?*
Do you have a fenced yard? (answer YES or NO).*
If you do have a fence, please describe: Height, Material, Approximate size of enclosure:
Do you have any health concerns or condition that affects the kind of dog that would be a good fit, or may do so in the future? If yes, please describe (i.e. asthma, allergies, lyme disease, arthritis)*
Please describe your typical weekly schedule, including *how many hours your dog will typically be alone, and *for how long, and *where will your dog be when left alone? :*
Doggie Wishlist

The following questions are to help us get an idea of what dog would be a good fit for you. There are no right or wrong answers, so please be as honest and accurate as possible.
Why do you want a dog?
Are you planning on a dog walker or daycare? If you are planning on using daycare or dog walking service please let us know who:
What kind of vehicle(s) will your dog be transported in? Would you use a secured crate or consider a seatbelt for your dog’s safety?
Describe how your dog be exercised daily i.e. a few blocks during the week, playing fetch in your yard, daily hiking on trails on leash, hiking off leash, long walks in neighborhood park, weekend hikes:
What daily activities are important for you to have your dog partake in i.e. dog park, hiking, good with other dogs, going to brewpubs, waiting in car while you run errands (when not hot), going to barbeques at friend's homes with other dogs/kids, joining family gatherings?
If you need to relocate, how will your dog fit into that plan?
Do you regularly have children or other guests visit your home? How often do children visit specifically? Will your dog be exposed to children on a regular basis (in parks, playground, home settings).
If you are in a relationship and you and your significant separate, what would happen to your pets?
Do you foresee any major life changes over the next two years? (e.g., promotion/transfer at work, military deployment, relationship change such as marriage, remodeling your home or yard, having children)
What physical and personality characteristics are you looking for in a dog (e.g., low-shedding, male/female, energy level, a training project or more of a stable dog with lots of history)? (the more info we have here, the better)
CoDa Canine rescues dogs of indeterminate origin from shelters, individuals, and organizations throughout Texas. While many of our dogs can look like purebred or nearly purebred, and we guess as to what breeds they may be, we do not make any guarantees as to their breeding or that their temperament will resemble that of the breed they look most like.

Questions Regarding Vet Care

What do/would you spend on the following categories of medical care?*

	$
Routine care (please provide the dollar amount you think is reasonable for annual non-emergency care)
Emergency medical (e.g., up to $1,000; up to $5,000; over $5,000)
Other/additional comments about medical care

What do you consider to be part of those expenses?*
Are you aware of health concerns related to over-vaccination in pets? Please answer YES or NO*
You can read more about this topic here; https://www.whole-dog-journal.com/health/beware-of-over-vaccinating-your-dog/
In the case of a treatable medical issue (example: bloat $5,000 surgery), what do you consider reasonable and manageable in terms of medical treatment, cost, quality of life, etc?
With the skyrocketing costs of veterinary care, have you or would you consider pet insurance? Please answer YES or NO.*
What brand of dog food will you feed your dog? Why this brand?*
We highly recommend researching dog foods and their ingredients at www.dogfoodanalysis.com and www.dogfoodadvisor.com.

Training & Behavior
Have you ever had a dog with behavior problems? If so what behavior(s) and how did you work with your dog on this issue?
If you are approved to adopt from CoDa Canine Obedience, you will be required to partake in a private lesson at our facility prior to taking your new companion home. Do you understand? *
Adopted dogs experience an adjustment period of at least several months. What do you expect that to involve and you are fully committed to adjusting your life to help your new dog learn to feel safe?*
Behavior

The first few months upon adopting tend to be the most difficult. Your new dog has been through many transitions, and your home is just one more transition in his mind. New behaviors can crop up, or previously seen behaviors can be amplified during the transition period. Working through these issues can be challenging and time consuming, and so please be as clear and honest as possible so we can help you get as close to the right fit as possible. Please note that dogs have the emotional capacity of a 3-4 year old child.
Please identify behaviors you would NOT be willing to work with:*
(e.g., growling at strangers, Lunging on leash at other dogs, nipping children, separation anxiety, leash pulling, housetraining accidents, counter surfing, other)
What steps would you take if upon adopting a dog that was represented as housebroken, your new dog began marking your furniture? Would you return the dog?*
What would you do if your new dog shows signs of separation anxiety? Such signs can include destructiveness, barking, whining, chewing, and scratching at doors. Would you consider returning? What would you do?*
Please list the TOP THREE most important behaviors that you would like to see reasonably quickly in your newly adopted dog (i.e. friendly with kids, good with cats, easy to walk on leash, housetrained, okay alone in the house, crate trained, quiet, food-motivated, okay with loud noises etc): *
If this dog will be an addition to an existing dog(s): Would you expect them to get along right away? Would separating them with babygates in your home be something you would do to try and help them develop a positive relationship? How long would you consider to be reasonable to ease in a new dog (i.e. days, weeks, months?) Please answer in detail below:*
What would you do if after several weeks at home with you, your newly adopted dog started barking at strangers whenever you took him for walks?*
Under what circumstances would you consider returning your adopted dog? Please think through this answer carefully i.e. nipped a jogger, bit my child, attacked my cat, bit my mother in law but did not require medical visit, bit the UPS man etc:*

Almost Done!
Have you ever lived with a dog from a rescue organization or shelter?*
What is your timeframe for adopting?*

Ready and eager for a dog this week; actively looking at shelters and surfing the internetApplying with multiple rescues; hoping for the right match in the next few weeksHappy to wait a few months for the right fitI am only applying for one specific dog, and if I don't get him/her I will look no further
Do you agree to contact CoDa Canine Obedience if after adoption you are unable to continue to be a guardian for your adopted dog, and either return your dog to us or work with us to find another suitable home for your dog? Please answer YES or NO.*
Do you agree to pay the $150 adoption donation? (Unless a dog is stated as “sponsored” , that is our standard adoption fee – a few “sponsored” dogs are a lower fee adoption fee, because an angel donor sponsored a portion of their fee). Please answer YES or NO.*
Please give a veterinary reference if you have one. A past reference is fine. Name, address, phone number please! Thank you. *
Please list three personal references (not a relative or household member), whom you have known for at least three years, who can vouch for your character as a pet guardian. Give name, address, phone, and email:
Reference One:
Reference #1; Name and Relationship, Address, Phone, Email*
Reference Two:
Reference #2; Name and Relationship, Address, Phone, Email*
Reference Three:
Reference #3; Name and Relationship, Address, Phone, Email*
Submission of this application confirms that you understand and agree to the need for screening of adopters, and certify that the information supplied on this application is true and correct. The terms “guardian” and “owner” shall be considered interchangeable. Please initial here that all your responses are truthful and complete.*
Should be Empty:

Doggie Wishlist

Behavior

Reference One:

Reference Two:

Reference Three: