ABDSR Adoption Application Form

Which dog are you applying for?

Full Name

First NameLast Name

Age

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home

*Format: (000) 000-0000.

Phone Number - Cellular

*Format: (000) 000-0000.

Do you live in a:

Do you:

If Renting or other: Please explain and indicate landlord contact information

Household Setting

Describe your Homes Activity Level

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)

What is your occupation?

Does Anyone in your Household have Allergies to Animals?

Are all members of your Family agreeable to Adopting a Dog?

Please List any Pets you have (Please include Name, Breed, Age, Altered, Gender, UTD Vaccines)

Have you ever surrendered a pet? Details

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?

How will you handle vacation and time away from your dog? Who will watch it while away?

Why are you interested in this breed?

Have you had any experience with with an emotionally or physically neglected or abused dog?

If Yes please explain

Are you willing to use a crate for this dog?

Do you have a fenced yard?

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

Are you willing to put up required fencing if you are not already set up. Are you allowed to modify property to add needed fencing? Can you put in Dig Guards?

What experience do you have with working breeds?

How many hours in a day would the dog be left alone?

What are your plans to exercise your dog?

Martial Status/kids/ages/who will be living in the household with the dog

Do you have a trainer you currently use?

Are you willing to do training if concerns or behavior problems arise?

Name of trainer/organization

Who will take care of the dog if you leave town?

Are you willing to return the dog to ABDSR if you are no longer able to care for the dog?

Please list 3 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?

Vet Reference: Full Name

First NameLast Name

Phone Number

*Format: (000) 000-0000.

Reference #1: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

example@example.com

Phone Number

*Format: (000) 000-0000.

Reference #2: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

example@example.com

Phone Number

*Format: (000) 000-0000.

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

example@example.com

Phone Number

*Format: (000) 000-0000.

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any ABDSR Rescue fostered/adopted by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless Alaska, Belgian and Dutch Shepherd rescue and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the adopted/fostered.

I accept full responsibility for the dog(s) actions at all times, and release Alaska, Belgian and Dutch Shepherd rescue any liabilities or damages that may be incurred because of fostering/adopting such dog(s).

I agree to have ABDSR complete reference call checks and conduct a home visit inspection to be able to approve my foster/adoption application.

I agree that if I'm unable to foster/own the dog(s) anymore that I will return the dog to Alaska Belgian and Dutch Shepherd rescue.

Date

MonthDayYear

Your name

E-mail

example@example.com

If you have any questions please message us or you can email us at akbelgiandutchshepherdrescue@gmail.com