Dog Adoption Application

Dog Adoption Application

You must be at least 21 years old to adopt!
Dogs and adopters are matched based on the best fit for each other, not in the order applications are received. We cannot estimate how long it will take to match dogs with applicants, but we will do our best to connect you as quickly as possible!

Adopting a pet is a serious commitment. Do not submit this application if you are trying to persuade someone to adopt this dog or believe that “once they meet the dog, they will want one.”

“ONLY complete this application if you’re ready to adopt NOW. Submitting before you’re ready wastes our volunteers’ time and slows down adoptions for dogs in need.”
Name and/or breed of the dog you want to adopt*
Applicant Information:
Adopter's NAME*

First NameLast Name
Adopter's Age

MonthDayYear
Co-Adopter's Information: NAME
First & Last Name
Co- Adopter's Age

MonthDayYear
Address *

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's e-mail*
example@example.com
Phone Number*
What is your preferred way for us to communicate with you?*

emailphone calltext
Who shares your household?*

Spouse/Life PartnerRoommate(s)Boyfriend/GirlfriendChildrenN/AOther
If there are children in the home. What are their ages?
Age of children
Is anyone in your home allergic to dogs?*

YesNo
How would you describe your dog owning experience?*

I have had dogs of my own as an adultI grew up with dogs or have worked with them but have not had my own as an adultI have never had one or have limited experience with dogsOther
Please list the Name, Breed, Age, Sex (indicate if spayed or neutered) of current or previous pets in your home within the last 5 years: *
If no current or previous pets, put N/A in this field
Have you ever given a pet of yours away or taken one to a shelter?*

YesNo
If yes, explain the circumstances in detail
Have you or anyone in the household ever been convicted (convicted includes guilty plea or no contest plea) of a violation of 18 Pa.C.S. § 3129 or Chapter 55, Subchapter B (relating to cruelty to animals) or of substantially similar conduct pursuant to an animal cruelty law of another state or Commonwealth?*

YesNo
References:
To expedite the processing of your application:
- Ask your references to return our call as soon as they can.
- Call your current or previous veterinarian's office and give permission to release information to our pet adoption counselor.
- Upload your veterinary records showing your pets are spayed/neutered and up-to-date on their vaccinations.
Upload Veterinary Records

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Please list ALL veterinary clinics and pet's name(s) in the past 5 years:
Please describe how you know this person(s) (e.g., neighbor, former coworker, pet sitter). Do not list family members.*
Home Information:
I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartment
Do you rent or own this property?*

RentOwn
If you rent, please provide a copy of you landlord's pet policy below or the name and phone number of your complex/landlord, if you own please put N/A. If you have a special living situation please explain below.*
Upload pet policy

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Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
If you would like to share photos of your home/yard, please do so here.
Upload Photos

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Compatibility Questions:
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 leashA total couch potato
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 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

What are you absolutely NOT WILLING TO DEAL WITH AT ANY TIME DURING THE LIFE OF THIS DOG? If there is nothing skip to question 18. *If filling out this section on a mobile device rotate device to landscape mode.

	PUPPY	YOUNG	ADULT	SENIOR
Fear of children
Fear of men
Fear of women
Chewing/Destructive
Excessive Barking
Jumping on People
Leash pulling
Housetraining
Food/toy aggression with other dogs
Food/toy aggression with people
Not friendly with other pets in the home
Protective of home & family
Bite provoked/unprovoked
Incontinence / Leaking Urine
Long Term Medication
Counter surfing

The number one reason why dogs are surrendered to a shelter or rescue is because they are not properly socialized or trained by their owner. The majority are between 6 months and 3 years old - and the length of ownership- is less than a year. Do you have a realistic idea of the amount of time and energy that you will need to dedicate to the dog’s training?*

YESMAYBENO
Are you willing to hire a professional dog trainer if needed and put in the work that it takes to have a well-behaved dog?*

YESMAYBENO
All dogs have their own unique personalities and temperaments. A dog’s upbringing, socialization, training, and environment will all play a role in its behavior and propensity for biting. Dogs rarely, if ever, bite for no reason. Us humans, (particularly children) often misinterpret a dog attacking “out of the blue” and “without warning” because we miss the warnings. 70% of reported dog bites are of children bitten by a dog that they know and love. You must be willing to teach your child/children to be gentle with your dog, respect their space, respect their possessions and behave nicely with them. Dogs don't like their tails being pulled, having their ears tugged, being cuddled really tightly or have a child on top of them. It's amazing what dogs will put up with before they go to bite but once they do, it doesn't generally end well for the dog.

Growling is a clear warning that should not be ignored. Don't scold a dog for growling, instead remove him/her from the situation. If a dog is scolded for giving a warning you're teaching him to go straight to biting. Put him in another room, his crate somewhere where he feels safe. You need to be able to pick up any early signs that your dog is getting stressed and intervening early.

Some breeds of dogs are genetically predisposed to be more aggressive than others making them excellent gaurdians. Do keep this in mind when adopting a dog/puppy known for these tendancies.
The role of responsible dog ownership cannot be overstated in preventing dog bites. Owning a dog is a huge responsibility and requires a lot of time, effort, and dedication. As a dog owner, you are responsible for your dog’s behavior and actions, and it’s crucial to prevent your dog from biting someone. Are you committed and willing to taking on this responsibility?*

YESNOOther
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family?*
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?
After you submit this form, it will take you to a Thank You Page and a link back to Diane's Pet Rescue home page.
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Dog Adoption Application

Applicant Information:

References:

Home Information:

Compatibility Questions: