Diane's 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 & Last Name
Adopter's Age

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

MonthDayYear
3. Address *

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's e-mail*
Phone Number*

Area codePhone Number
Cell Phone Number

Area CodePhone Number
4. What is your preferred way for us to communicate with you?*

emailphone calltext
5. 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
6. 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
7. Name, Breed, Age, Sex (indicate if spayed or neutered) of current or previous dogs in your home within the last 5 years:*
If no current or previous pets in home put N/A in this field
8. Are your current pets up to date with vaccines, heartworm and flea/tick prevention?*
If no current pets in home put N/A in this field
9. A veterinarian reference will fast track your application. PLEASE call your vet. and give permission to release information to our pet adoption counselor.

Veterinarian Name of Veterinary office
Veterinarian Phone Number

Area CodePhone Number
10. Name and Phone # of one personal reference that is NOT a family member. If not providing a veterinarian reference, please provide two personal references*
11. 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
12. Have you ever given a pet of yours away or taken one to a shelter?*

YesNo
If yes, explain the circumstances in detail
13. Is anyone in your home allergic to dogs?*

YesNo
14. I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartment
15. 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

Browse Files

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16. Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
17. 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
18. 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

19. What are you 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.

Rows	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

20. 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
21. 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 guardians. Do keep this in mind when adopting a dog/puppy known for these tendencies.
22. 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 take on this responsibility?*

YESNOOther
23. What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family?*
24. 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: