Adoption Application

Name of dog you would like to Foster-To-Adopt

Full Name*

First NameLast Name

Age*

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Do you live in a:*

Do you:*

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Describe the Activity Level in your Home*

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?*

YesNo

Are all members of your Family agreeable to Fostering-to-Adopt a Dog?*

YesNo

Please List any Pets you have Living or Deceased (Please include Name, Breed, Age, Altered, Sexe, UTD Vaccines, Heartworm, Living/Deceased)*

Would you be willing to have a SSRRT Team Member call your veterinarian for a reference check? (Please authorize vet to speak with us)*

YesNo

Veterinarian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

List name and phone number of 2 unrelated personal references.*

Are you willing and able to maintain veterinarian care including preventatives?*

YesNo

Rescue dogs often have an unknown history. Do you understand your dog may not be house trained, crate trained, etc? Are you able to work with the dog on these types of issues?*

YesNo

Are you willing to use a crate for a dog if recommended?*

YesNo

Do you have a fenced yard? (This question does not exclude potential adopters. We are only trying to ascertain a good fit)*

YesNoPartial

How many hours in a day would the dog be left alone?*

Any additional information you would like us to know.

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any Stephanie's Sheperds dog fostered and/or subsequently adopted by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless Stephanie's Shepherds and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the dog whether fostered or adopted.

I accept full responsibility for the dog(s) actions at all times, and release Stephanie's Shepherds from any liabilities or damages that may be incurred because of such dog(s).

I agree to have Stephanie's Shepherds complete reference call checks and conduct a home visit if necessary, to be able to approve my foster application.

I agree that if I'm unable to keep the dog(s) anymore that I will return the dog(s) to Stephanie's Shepherds.

I understand finalization of adoption requires a contract and adoption fee.

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MonthDayYearHourMinutesAM/PM Option

Your name*

Co-Applicant name (if applicable)