Dog Adoption Form

Dog Adoption Form

Dog Adoption Application
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long at this address?:
Are you planning on moving within the next 6 months?
If yes, what are your plans for your pets if you move?
Cell Phone Number

Area CodePhone Number
Name of Employer:
Work Phone Number

Area CodePhone Number
E-mail
Are you 18 years of age or older?
Birth Date

MonthDayYear
Do you own your own home?
If no, name and phone # of landlord:
Type of Dwelling:
Name and age of ALL occupants in household (including yourself):
If no children, do you plan on having children or will children be visiting the household frequently?
What is your reason for wanting to adopt a dog?
If other, please explain:
How many total hours will your new pet be left alone during the day?
How many total hours will your new dog be outside alone during the day?
If adopting a puppy, where would the puppy be kept when alone?
Do you have a fenced yard?
If yes, which type of fence?
If yes, how tall is your fence?:
Do you have locks and/or latches on all your gates?
Are any members of your household allergic to animals?
If yes, please describe:
Who will have chief responsibility for the care of your new pet?
Over the past 5 years, how many pets have you owned? (Include current pets)
List each individually including breed, age, still living with you? (if not, why?)
If you currently own a dog or cat, how does he/she react to new pets?
Are your present pets up-to-date on their annual vaccines?
If no, please explain:
Are your present pets spayed or neutered?
If no, please explain.
Were your previous pets spayed or neutered?
If no, please explain.
How much are you financially prepared to spend for routine/emergency medical care, licensing, etc?
What plans do you have for your new pet when you are on vacation?
Which dog(s) are you interested in?
Who is your current or most recent veterinarian? Please provide their NAME and PHONE NUMBER:
If your dog displays behavioral problems (such as jumping on people,excessive barking, potty accidents, etc.) how would you go about correcting the behavior?
If other, please explain:
What type of solution would you be willing to try if housebreaking accidents continue after the first week (check all that apply)?
If other, please explain:
Is your entire immediate family in agreement with the decision to bring a new pet into your home?
If anyone is NOT, please explain:
Are you prepared to commit to a pet for 15 - 20 years (average life span)?
Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?
If yes, please describe:
Have you ever adopted or tried to adopt a pet from us before? If yes, fill out info below.
Pet’s Information

Pet’s NameCat or Dog?Adoption/Application Date
Where will your dog spend most of his/her time?
If you selected outdoor, would your dog be supervised?
Where will your dog sleep?
Please provide 2 personal references (only 1 can be a relative) that can testify to your responsibility and ability to care for your animals. This is required or your application cannot be approved.
Reference #1
First and Last Name & Relationship to Self
Reference # 1 Phone Number

Area CodePhone Number
Reference #2
First and Last Name & Relationship to Self
Reference #2 Phone Number

Area CodePhone Number
If there is anything else you think we should know, please note it here.
Adoption Agreement and Waiver I assume responsibility for any events that occur in connection with my adoption of an animal from Rescue Me Animal Advocacy. I understand the possibility of my children or others being bitten, scratched, or contracting disease does exist. I agree to be responsible for my children and anyone else handling any animal(s) adopted by me in a safe and hygienic manner, and will not hold Rescue Me Animal Advocacy responsible for any injuries that may result from my failure to do so.I understand that Rescue Me Animal Advocacy cannot and does not make any representations or warranties, either expressed or implied concerning the temperament, habits, health, pedigree, disposition, age, sex or background of this animal and that I have no right to a reimbursement of medical, adoption or other professional fees. Furthermore, I understand that the animal’s future reactions to me, my family or any other person are completely unpredictable because animals, like people, have their own personalities.In consideration of receiving any Rescue Me Animal Advocacy adopted animal, I, as adoptee, hereby release Rescue Me Animal Advocacy, its officers, agents and employees from all claims of injury or damage that a fostered dog/cat/other may cause me or my property. I agree to hold harmless, defend and indemnify Rescue Me Animal Advocacy, its officers, agents and employees from any and all claims of liability to other people for injuries or damage arising out of or in connection with services of this program or caused to them or their property by the animal(s) I am adopting through Rescue Me Animal Advocacy. Bysigning this application, I am stating that I have answered all questions completely and truthfully.
Signature
Thank you so much for wanting to rescue a dog!!
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