Dog Ownership Application Form

Dog Adoption Application
Please give careful consideration to adopting an animal.

Animals are not toys or short-term commitments.

Make sure your lifestyle allows the time, patience and expense this animal will need over the years.
If approved for adoption, there will be a contract to return the dog to Nikki Bukouras if adopter is no longer able to care for the dog, for the entire life of the dog.
Name of the animal you want to adopt*
Adopter's Name*
First & Last Name
Co-Adopter's Name
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's E-mail*
Co-Adopter's E-mail*
Phone Number*

Area CodePhone Number
Phone Type*

CellHomeWork
Names and ages of all permanent residents of your home (adults/children)*
Vet reference (please call your vet and give permission to release information to us)*
Vet name, address & phone number
Current pets in your home*
Where are your current pets kept?*
Have you had other animals as pets in the past?*

YesNoOther
If yes then what happened to them?*
Please list your former pets here.*
Are you planning to move in the near future?*

YesNo
If moving soon, to what city/state?
When will you be ready to adopt this pet?*

TodayThis weekendWithin a weekWithin a monthNot ready yet, just researchingOther
Are you in contact with any other rescues or shelters about a specific animal?*

Yes, application is pendingYes, just an email inquiry, no app yetNo, but I am looking at several onlineNo, I am only interested in this particular animal
Are you going to meet another animal?*

YesNo
If so, when?
Is anyone in your home allergic to animals?*

YesNoOther
Does anyone in your home fear this type of pet?*

YesNoOther
Does anyone in your home smoke?*

YesNo
Are you familiar with pet regulations in your area?*

YesNo
If you answered no to the question above, please contact your town/county/condo assoc and ask them what the regulations are.
If yes, please describe local regulations, any insurance requirements, and any restrictions:
I/We live in a*

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

RentOwnOther
If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any limitations. Or you can provide us with your landlord's contact information below.

If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.
Landlord Contact Information
Do you have a pool?*

YesNoPlanning to get oneWe have a pond on our propertyOther
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
If fenced, fence height is:

2' high3' high4' high5' high6' high
What will you do if your dog chews furniture or shows other destructive behavior? *
Are you familiar with the feeding recommendations for a dog/puppy? *
Are you willing to take the dog to training classes?*
Do you work outside the home?*

YesNoOne applicant is home/works from home
If you both work outside the home, how many hours per day are you away?
How many hours per day will this dog be alone? Explain*
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
We will be speaking to all household residents to confirm everyone is aware of this application process and wants to have a dog added to the family. Please do not submit this application if you are "trying to talk someone into" adopting this dog or think "once they meet the dog, they will want one" or "I'm getting this dog as a birthday present for them." In those scenarios, you are welcome to email us to discuss the dog, but we would like all adults in the home to be involved in that email discussion.
Based on the descritpion in the dog's bio, do you feel pretty confident that you will be likely to adopt this dog upon meeting it?*

YesNoNot sure
Upon meeting the dog, what would give you cause to not want to adopt it? Please explain.*
Fantasy question: What would your dream dog be like? (If this dog is not a fit, we may be able to recommend another based on what you say here.)*
How much do you feel you can reasonably afford and would be willing to spend on your dog per year (for things like veterinary care, licensing, ID tag, food, toys, crate, other supplies, training, pet sitting, etc)? *
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 leash, a total couch potatoOther
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 train/use as an assistance dog for the disabledTo 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
Please check all that apply. My adopted dog will...

Be kept outside most of the timeBe kept indoors most of the timeBe left outside during the work day while we are awayBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usTake frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenMust be housebroken prior to adoptionWill be housetrained by usWe be walked more than one mile per day every dayWill be walked occasionallyTied out during the day while we are at work.Be attending formal group obedience classes with usBe trained by us without the advice of a trainerHave private sessions with a trainer as neededBe attending agility classesBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe given away to someone else if we feel it's not a good match for usBe turned in to a shelter if we can't keep itBe going camping with usBe going on boat trips with usOutside free roaming while we are at work.Sleeping in bed with us.Sleeping in a crate at night.Other
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?*

HousebreakingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenMouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training)GrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingCounter surfingBlindnessLimited SightDeafnessSeparation AnxietyDiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineTaking classes with the dogGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin allergiesFood allergiesTrimming nailsYeast on coat or in earsEar mitesFleasTicksHeartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
What would cause you to return a dog?*
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family?*
How do you plan to integrate this dog into your family?*
What would you do if you discovered after adoption (at any time during the life of the dog) if your vet diagnosed an expensive health condition?*
Do you plan to get pet health insurance?*

YesNoI wasn't aware this was available. I will look into it.
What brand of dog food do you plan to feed?*
Grooming (please check all that apply)*

We use a professional groomerWe trim dog nails ourselves at homeWe bathe our dogs at home once a weekWe bathe our dogs at home once a monthWe bathe our dogs at home once every few months or whenever their coat feels dirtyWe bathe our dog twice a yearWe don't bathe our dogWe check ears weekly for infection/yeast/mitesWe check coat daily for ticks in spring/summer/fallWe clean teeth using home methodsWe take our dogs to the vet for dentals whenever the vet recommends this is neededPrefer a dog that doesn't shedDon't care about shedding
How long have you been looking for a dog?*
Do you plan to take formal obedience classes?*

YesNo
Additional reference (if desired)
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?*
Applicant's Signature*
Co-Applicant's Signature
Email
example@example.com
Today's Date*

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Dog Adoption Application