[PDF to Form] GSSD Adoption Application1..

Gem State Service Dogs & Rescue, Inc is a 501 c3 non-profit dog rescue.  We are an all-volunteer, foster based animal welfare organization dedicated to the rescue and placement of stray, neglected, surrendered,  and abused dogs. We have a non-refundable adoption fee. We do not provide transport, unless noted on  the dogs listing, but can provide referrals to reputable Dog Transporters.  &#13;&#10;&#13;&#10;This questionnaire is designed to help GSSDR, Inc. and yourself determine if a specific dog is the right one for you and your household. All parties interested in adopting a dog from GSSDR are required to complete this form prior to meeting the dog or adoption. GSSDR, Inc reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions.

Dog you are applying for

Your Full Name

First NameLast Name

DOB

Complete Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How long at this home address?

Phone

Format: (000) 000-0000.

Email

example@example.com

Occupation

Housing Type

Do you Own or Rent Your Home

If you rent, are there any weight or breed restrictions?

Do you have a fenced yard?

Fence Material & Height

Landlord Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

***Renters: It is required to have verification of approval to have a dog***

List all adults (full name) & DOB living in the home.

Has anyone in the home been convicted of a crime?

Children (How Many & Ages)

Have you owned a dog/ rescue dog before?

If so, What Breeds & Ages

Any dogs currently in the home

Dogs in the home: List Breed, Sex, Age

Are all dogs Spayed/Neutered?

Any cats in the home or on the property?

Why are you interested in adopting a dog at this time?

Does anyone in the home have a dog allergy

Who would be responsible for the care of this dog?

Do you plan on keeping the dog, Inside/Outside/Both

Have you ever rehomed a dog?

If so, please explain.

Where will your dog be kept when unattended or you’re at work?

Where will your dog sleep at night?

What is your opinion about using a crate?

Are you aware that the dog may not be housetrained to YOUR home?

Do you understand there is an adjustment period into a new home of 3-4mo.

Do you agree to let us help you through that adjustment period

Have you attended obedience training in the past?

If your dog is ill behaved, would you seek advice from a Professional Trainer before giving it up?

Briefly explain your training style.

When do you plan to bring home your new furbaby?

What do you plan to feed your new pet? (Brand of food)

Do you agree to feed what the rescue suggests for food allergies?

What do you estimate yearly expenses to be for a dog?

Have you considered Pet Insurance?

Name or your current or past Vet?

Phone Number for your Vet

Please enter a valid phone number.Format: (000) 000-0000.

Are you prepared to physically, emotionally & financially take care of your pet for the rest of it's life?

Do you have any questions for us regarding the adoption process?

Have you applied with other rescues?

How did you hear about us?

References: (PLEASE NO FAMILY MEMBERS)

Personal Reference #1 (no family members)

First NameLast Name

Phone Number - Reference #1

Please enter a valid phone number.Format: (000) 000-0000.

Personal Reference #2 (no family members)

First NameLast Name

Phone Number - Reference #2

Please enter a valid phone number.Format: (000) 000-0000.

I(we) agree that everyone in the home over 18yrs old must agree to allow Gem State Service Dogs & Rescue (GSSDR) to conduct a public records check, reference check and/or agree to a home visit by a member of the board for GSSDR or a designated party of the Rescue's choice or by video if out of the Boise, ID area.

I understand by applying does not guarantee approval for adoption and that dishonest answers or failure to comply with the requirements of this application may result in a denial of adoption for any animal owned by GSSDR.

I affirm that the facts set forth on this applicaion are true and complete to the best of my knowledge. I understand that any false statements, omissions or misrepresentations made by me (the aaplicant) on this application, may result in an immediate denial for adopting a dog from GSSDR.

Signature

Date

Pre-Adoption Screening Application