BURNSIDE PAWS

Burnside Paws Animal Rescue Dog Adoption Application
Burnside Paws Rescue is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals mostly dogs listed for euthanasia. Burnside Paws Rescue is completely funded through fundraising efforts and public donations.
This questionnaire is designed to help Burnside Paws Rescue and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Burnside Paws Rescue reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!

Please Note that $600 upfront will be required to any dogs being requested to pull off of the euthanasia list. If you agree to this, we look forward to helping you adopt your new best friend.
Applicant Information

IMPORTANT: Please fill in all fields. is no answer, please fill in “N/A” Also, please include dogs A #. If any fields are missing the application will be denied. thank you for understanding!!!
Name of the dog you are interested in:*
Your full name:*
Your age:*
Street Address:*
City, State, Zip*
Home Phone:

Area CodePhone Number
Work Phone:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
E-mail:
Employer:
Personal reference and phone number:
Household Information
Are all members of your household in agreement with this adoption?*

YesNoDon't Know
Who will be the pet's primary caregiver?*
Do you live in a*

HouseApartmentCondoMobile HomeOther
Do you own or rent?*

OwnRent
If rent, provide name and phone number of landlord:
Does your landlord allow dogs?

YesNo
Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone
Do you have a fully fenced yard?*

YesNo
Height and type of fence
Do you have any of the following?

Underground fenceKennelDog Run
How many adults are in your household?*
How many children are in your household?*
If children, what are their ages?
Have your children been around animals before?

YesNo
Does anyone in your home have allergies to dogs or have asthma?*

YesNo
Current/Previous Pet Information
List any pets you own or have owned in the past five years, and their ages
How many of these pets are spayed/neutered?
Where are these animals now?
Have you adopted from an animal rescue group before?

YesNo
If yes, what group?
Have you ever given up a pet?

YesNo
If yes, what were the circumstances?
Please provide the name and phone number of your current and/or previous veterinarian or clinic:
New Pet Information
What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*
Are you aware of crate training?*

YesNo
Have you ever house-broken a dog or puppy before?*

YesNo
If the dog has an "accident" in your home, what type of correction do you plan to use?*
How many hours each day will your new pet be home alone?*
Where will your new pet sleep at night?*
How will you supervise the dog's outdoor activity?*
Where will your new dog stay when nobody is home?*
What length of time will you allow your new pet to adjust to his new home?*
Are you willing to work through your new pet's issues, if any?*

YesNo
Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo
Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for?*

YesNo
Do you plan to take an obedience class with your dog?*

YesNoNot sure
If yes, where?
Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for?*

YesNo
What circumstances would lead you to give up your new dog?*
If you had to give up your dog, what would you do with him/her?*
How did you find out about Burnside Paws Rescue?*

Petfinder.comFacebookFriend/Family MemberOther websiteOther
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.

By submitting an application to Burnside Paws Animal Rescue person(s) recognize application will be reviewed and processed by members of Burnside Paws Rescue. Applicant grants permission for listed veterinarian to release medical information to Burnside Paws. Burnside Paws may utilize information submitted to do a compliant DMV and criminal background check. Any references are granted permission to speak to a representative of Burnside Paws doing background for application to adopt a rescue dog *
Should be Empty:

Burnside Paws Animal Rescue Dog Adoption Application

Applicant Information

Household Information

Current/Previous Pet Information

New Pet Information