Dog Adoption

Dog Adoption
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How Long at this Address? * Own/Rent? *
Home Phone
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Alternative Phone
Please enter a valid phone number.
Best Time to Call*
Place of Employment*
Email*
example@example.com
Home Information If you rent: provide information from lease regarding pet policy and full name/contact information for your landlord. *
(By providing this information you are allowing a call to your landlord; please call your landlord and advise them of your application).
How many children are in the home? * Ages *
What type of home do you live in?*

ApartmentSingleFamilyHomeFarmOther
How big is your yard? *
Fenced in yard ( mandatory only for dogs who require )*

YesNo
How high is the fence?
Does anyone in the house have any known allergies to animals? *
Other Pets:What other pets do you have in the home: Please specify how many, type, breed, age: *
Are they spayed/neutered?*

YesNo
If No, Why?
Are they all up-to-date with vaccinations?*

YesNo
If No, Why?
Any behavioural issues: (food/toy possessive, guarding issues etc.):*
Veterinarian: Vet’s Name, Clinic Name, Clinic Address, Clinic Phone number: *
(By providing this information you are allowing a call to your Veterinarian; please call your vet and authorize the release of information. Thank you).
Adoptive dog: Tell us what you are looking for. Name of pet wanting to adopt:
I am looking to adopt a dog. Have you had a pet before? * How Many? *
What Happened to them?
Why Would you like to Adopt?*
Desired Age? * Breed? *
Temperament * Size *
Desired Sex?*

MaleFemaleEither is fine
Will you be willing to adopt a pet that:*

Requires regular medication:Needs training:Needs grooming:High energy:All of the AboveNone of the Above
Are you willing to work with dogs with:*

Separation anxietyReaction to otherExcitabilityMild Aggression:VocalizationHouse training:Guarding:Fearfulness:All of the AboveNone of the Above
Where will the pet spend the day? (crate, outside, house, etc.) *
Where will the pet spend the night? (crate, outside, house, etc.) *
Number of hours (average) pet will spend alone: *
Where will the pet stay while you are on vacation? *
Have you ever been convicted of animal cruelty or neglect?*

YesNo
Do you agree to provide regular health care by a Licensed Veterinarian?*

YesNo
Under what circumstances would you return your pet? *
Do you agree to contact and return the pet to Northern Animals Rescue & Sanctuary if you cannot keep or provide for the pet?*

YesNo
Are you willing to have a representative of Northern Animals Rescue & Sanctuary to do a home visit? If Not, Why? *
All the Information I have given is true and complete. This dog/cat will reside in my home as a pet.

Falsified information will lead to automatic rejection of the application. Northern Animals Rescue & Sanctuary reserves the right to refuse any applicant.

I understand that it is my responsibility to see and evaluate the pet myself before agreeing to adopt. The adoption of a lifelong animal companion should not be impulsive, but rather a carefully thought out decision which will ensure a lifelong, lasting, loving relationship.

I am aware that all animals can possess medical conditions that may be undetectable at the time of adoption and I accept all responsibility and financial obligations for treatment at my veterinarian office and hereby agree to be fully responsible for the physical and medical care of the pet.

I am aware that pets may exhibit normal but potentially undesirable behaviours including aggression, house soiling, biting, scratching people or furniture, digging, etc, and I agree to work with the pet and/or trainers if necessary to resolve any issues.

I agree to be financially responsible for any expenses and veterinary costs related to this pet.

If the Adopter does not wish to maintain possession of and care for the pet, the Adopter hereby agrees to promptly return and relinquish ownership of the pet to Northern Animals Rescue & Sanctuary. The Adopter shall not transfer ownership or long-term care of control of the pet to a third party without written consent to Northern Animals Rescue & Sanctuary.

The Adopter agrees to take no action which is intended, or would reasonably be expected, to harm Northern Animals Rescue & Sanctuary or its reputation or which would reasonably be expected to lead to unwanted or unfavourable publicity.

The Adopter agrees to pay a non-refundable adoption fee of one of the following (Adult dog $375.00, Puppy $475.00, Cat/ Kitten $225) to adopt the pet.
Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
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