Animal Adoption Application Form

Flounders House Inc. Dog Adoption Application
Please complete all the information on the following pages. Missing information may delay the adoption screening process. Completing this application form does not guarantee that Flounders House will place one of our pets in your care. Completing this questionnaire authorizes Flounders House/ Rachel-Leah McDonald to verify any information contained herein, including verification of medical records of any present or prior pets treated by the veterinarians listed. Completing this adoption process indicates that you have read, understand and agree to abide by our Animal Adoption Agreement and that the information contained within this application is accurate and not misleading in any way. All adoptions are at the sole discretion of Flounders House

Please give careful consideration to adopting a dog. Dogs are not toys or short-term commitments. Make sure your lifestyle allows the time, patience, training, and expense this dog will need over the years. DO NOT APPLY IF YOUR PARTNER,SPOUSE, OR FAMILY IS NOT ONBOARD.

All pets will vaccinated, heartworm tested, and treated for parasites before adoption. Approved local adopters are expected to travel to Winhall Vermont to pick up their pets. Dogs too young to be spayed/neutered will need to sign a contract and give a 100.00 refundable deposit. Deposit will be returned upon vet verification of spay/neuter. Older dogs will be spayed/neutered before adoption.
Name of the animal you want to adopt*
Adopter's Name*
Co-Adopter's Name
Address*
Address
City*
Adopter's Email*
Co-Adopter's Email
Phone Number*
Phone Type

CellHomeWork
Names and ages of all permanent residents of your home adults/children*
Annual Household Income

Under $25,00025,000-50,00050,001-70,00070,001 or higher
Vet reference please call your vet and give permission to release information to us
Vet name, address & phone number
Where are your current pets kept
Have you had other animals as pets in the past

YesNoOtherOther
If yes then what happened to them
Please list your former pets here
Are you planning to move in the near future

YesNo
If moving soon, to what city/state
When will you be ready to adopt this pet

TodayThis weekendWithin a weekWithin a monthNot ready yet, just researchingOtherOther
Are you in contact with any other rescues or shelters about a specific animal

Yes, application is pendingYes, just an email inquiry, no app yetNo, but I am looking at several onlineNo, I am only interested in this particular animal
Are you going to meet another animal

YesNo
If so, when?
Is anyone in your home allergic to animals

YesNoOtherOther
Does anyone in your home fear this type of pet

YesNoOtherOther
Are you familiar with pet regulations in your area

YesN
If you answered no to the question above, please contact your town/county/condo assoc and ask them what the regulations are.
If yes, please describe local regulations, any insurance requirements, and any restrictions
I/We live in

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartmentOtherOther
Do you rent or own this property

RentOwnOtherOther
If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any limitations. Or you can provide us with your landlord's contact information below. If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.
Landlord Contact Information
Do you have a pool

YesNoPlanning to get oneWe have a pond on our propert
If you have a pool or pond, please describe how you will prevent your adopted dog from drowning.
Do you have a yard

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
If fenced, fence height is:

2' high3' high4' high5' high6' high
What will you do if your dog chews furniture or shows other destructive behavior?
Are you familiar with the feeding recommendations for a dog/puppy?*
Are you willing to take the dog to training classes*
Do you work outside the home

YesNoOne applicant is home/works from hom
If you both work outside the home, how many hours per day are you away?
How many hours per day will this dog be alone? Explain
Have you discussed this adoption with all members of your household

YesNoYes, adults have discussed. Kids don't know yet.
We will be speaking to all household residents to confirm everyone is aware of this application process and wants to have a dog added to the family. Please do not submit this application if you are "trying to talk someone into" adopting this dog or think "once they meet the dog, they will want one" or "I'm getting this dog as a birthday present for them." In those scenarios, you are welcome to email us to discuss the dog, but we would like all adults in the home to be involved in that email discussion.
Based on the descritpion in the dog's bio, do you feel pretty confident that you will be likely to adopt this dog upon meeting it

YesNoNot sure
Upon meeting the dog, what would give you cause to not want to adopt it? Please explain
How much do you feel you can reasonably afford and would be willing to spend on your dog per year (for things like veterinary care, licensing, ID tag, food, toys, crate, other supplies, training, pet sitting, etc)?
What activity level do you prefer?

Wild and crazy is coolLeash trained daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potatoOtherOther
Please check all that apply. I want to adopt this dog..

As a family petTo breed with my dogTo train/use for huntingTo train/use for agilityTo train/use as a therapy dogTo train/use as an assistance dog for the disabledTo use as a guard dogFor a jogging/hiking partnerTo interact with lots of friends/familyAs a gift for a friendAs a companion for my dog(s)As a companion for my cat(s)As a companion for my child/children
Please check all that apply. My adopted dog will...

Be kept outside most of the timeBe kept indoors most of the timeBe left outside during the work day while we are awayBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/u
Take frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenMust be housebroken prior to adoptionWill be housetrained by usWe be walked more than one mile per day every dayWill be walked occasionallyTied out during the day while we are at work.Be attending formal group obedience classes with usBe trained by us without the advice of a trainerHave private sessions with a trainer as neededBe attending agility classesBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe given away to someone else if we feel it's not a good match for usBe turned in to a shelter if we can't keep itBe going camping with usBe going on boat trips with usOutside free roaming while we are at work.Sleeping in bed with us.Sleeping in a crate at night.Other
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog*
HousebreakingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenMouthiness may sometimes snag your hand or arm instead of the toy in play and will needGrowlingBarkin
High activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingCounter surfingBlindnessLimited SightDeafnessSeparation AnxietyDiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineTaking classes with the dogGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin allergiesFood allergiesTrimming nailsYeast on coat or in earsEar mitesFleasTicksHeartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any trainingOther
What would cause you to return a dog
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family
How do you plan to integrate this dog into your family
What would you do if you discovered after adoption (at any time during the life of the dog) if your vet diagnosed an expensive health condition
Do you plan to get pet health insurance

YesNoI wasn't aware this was available. I will look into it.
Grooming please check all that apply

We use a professional groomerWe trim dog nails ourselves at homeWe bathe our dogs at home once a weekWe bathe our dogs at home once a monthWe bathe our dogs at home once every few months or whenever their coat feels dirtyWe bathe our dog twice a yearWe don't bathe our dogWe check ears weekly for infection/yeast/mitesWe check coat daily for ticks in spring/summer/fallWe clean teeth using home method
How long have you been looking for a dog*
Do you plan to take formal obedience classes

YesNo
Additional reference (if desired)
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog
PLEASE READ: The adoption fee covers fully vetting the dog, which includes: spay (for females), neuter (for males) (UNLESS THEY ARE TOO YOUNG!), 4DX test (checks for heartworms and tick-borne diseases), fecal test (to check for worms and intestinal parasites), rabies vaccination, distemper combo vaccination, wormer, a dose of flea/tick preventative (which will kill fleas/ticks and provide a month's worth of protection against them) and grooming if needed. Your adoption fee will be the actual cost of all of this vetting, plus any transport charges. You are required to take your dog to the vet within two weeks of adoption.
Applicant's Signature*
Co-Applicant's Signature
Today's Date*
Should be Empty: