[PDF to Form] GSSD Adoption Application1..

Type a question

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 *

HouseApartmentTownhome/CondoOther

OwnRent

YesNo

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.*

YesNo

Children (How Many & Ages)*

YesNo

If so, What Breeds & Ages*

YesNo

Dogs in the home: List Breed, Sex, Age*

YesNo

YesNoYes, but controlled by mediction

Who would be responsible for the care of this dog?*

InsideBoth inside/outsidePrimarily outsideMostly inside, outside to potty & play

YesNo

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?*

YesNo

Briefly explain your training style.*

Immediately!! I can't wait1-2 weeks - I need a little time to get ready2-3 months - I am looking but not sure who I wantMore than 4 months - I'm just gathering information to make the best decision

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

YesNo

$300 - $500$500 - $1000$1000 - $1500Over $1500

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? *

YesNo

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*

Date

Pre-Adoption Screening Application