Stranger Days Street Dog Rescue Corp
Adoption Form
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Partner / Spouse Name (if applicable):
First Name
Last Name
Partner / Spouse Phone Number
-
Area Code
Phone Number
Email Address
*
Address Pet Would Reside
*
Street Address
Street Address Line 2
City
State
Postcode
Do you own or rent your home?
*
Own
Rent
Other
Years at Current Residence
Does your residence have breed/size restrictions? If so, what are they?
*
Do you plan to move in the future?
Yes
No
If yes, would your move include your pet?
Yes
No
Do you have a fenced in yard?
*
Yes
No
Other
Are you willing to have a home check?
*
Yes
No
Do you have adequate space and time necessary to provide the pet with proper exercise and training?
*
Yes
No
Will you provide proper veterinary care for pet (vaccines, flea/heartworm prevention and medical treatment)?
*
Yes
No
Will you provide training for the dog if needed?
*
Yes
No
Name of Pet You Wish to Adopt or description if general enquiry (e.g. dog small breed)
*
Where would the pet sleep?
*
Where will the pet staywhen you are not home?
*
Do you have children in the home?
*
Yes
No
If yes, what are the ages?
Do you have any other pets in the home? If so, what kind?
*
If you have other pets, how many are vaccinated and altered?
*
Please provide your veterinarian's name and phone number:
*
Reference 1 Name
*
Reference 1 Phone Number
*
-
Area Code
Phone Number
Reference 2 Name
*
Reference 2 Phone Number
*
-
Area Code
Phone Number
If for any reason you can't keep the pet, you agree to return him or her to Stranger Days Street Dog Rescue Corp?
Yes
No
Please provide us with any additional information you think we should know
By clicking the submit button, I understand that as part of the adoption process, Stranger Days Street Dog Rescue Corp may conduct a home and yard check if applicable.
By clicking the submit button, I understand Stranger Days Street Dog Rescue Corp may check my veterinary references.
By clicking the submit button, I understand there is an adoption fee associated with adoption of a pet from Stranger Days Street Dog Rescue Corp.
I understand that if my circumstances change and I am unable to provide care for this pet, returning them to our rescue is a requirement.
By clicking the submit button, I verify all of the above information is true and accurate.
Signature of Applicant
*
Submit
Should be Empty: