Canine Adoption Application
Canine Adoption Application
We are an all-volunteer, non-profit animal welfare organization committed to rescuing and rehoming stray, neglected, and abused animals. Fully funded through fundraising efforts and public donations, our dedicated team ensures that every dog is cared for in foster homes and receives comprehensive medical care, including deworming, vaccinations, spaying/neutering, microchipping, and any necessary medical treatments prior to adoption. Additionally, our dogs undergo various training programs to prepare them for their new homes. This questionnaire is designed to help both you and us determine if a specific dog is the right fit for your family and household. All adopting parties must complete this form prior to adoption, and we reserve the right to deny any adoption based on the information provided in the questionnaire or interviews. Please note that it may take a few days for us to respond. Adoption fees range from $75 to $650, depending on the dog’s age, medical needs, and placement level. Please text 631-353-2416 for any questions!
Personal Information
Name of the Dog(s) you are applying for.
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If the Dog you are applying for is on hold, adopted, or is not a good fit for your home. Are you interested in learning about other dogs that are potential matches?
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Full Name
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First Name
Last Name
Cell Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
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example@example.com
Current Full Address (Where you and the dog will be living.)
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Age
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Date of Birth
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Month
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Day
Year
Date
Drivers License ID#
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Occupation
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Gender
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Household Info
Is this your first time owning a dog?
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Yes
No
Other
Who will be the dog's primary care giver?
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Are you planning on moving within the next year?
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Yes
No
Maybe
Are you planning on having children within the next couple of years?
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Yes
No
Maybe
How many years have you lived at your current address?
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What do you live in?
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House
Condo
Apartment
Mobile Home
Town House
Other
Do you rent or own?
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Rent
Own
I live with my parents
Other
If you selected "Rent" or "I live with my parents" please provide us with the landlords' or parents' full name and phone number.
Does your landlord or parent allow you to have a dog in the residence?
Yes
No
Other
Are there any restrictions to the dog you can have?
Breed Restriction
Weight Restriction
Number of Pets Restriction
Other
If there are restrictions, please elaborate what they are. (I.e I cannot have a dog over 50lbs.)
Do you have a fenced in yard?
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Yes
No
Partially
Other
What is the height and type of the fence?
Please list the ages of everyone in your household, adults and children.
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Do children visit your home? If so, what are they ages?
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Have the children in your household lived with animals in the home before? If yes, what kind?
Does anyone in your home have allergies to dogs or asthma?
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Yes
No
Other
Previous/Current Animal Experience
What Animal Experience do you have?
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Do you have a preference for breed, sex, age, size, or hair length? If so, what do you prefer?
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Please list any and all pets you have owned in the past 10 years. Please add their species, gender and age.
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Does your animals at home have any behavioral concerns? If yes, which ones?(Example: resource guarding, fearful)
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Are the pets in your home/care spayed/neutered?
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Yes
No
Other
If no, please explain why.
Have you adopted a dog from an animal rescue or shelter before?
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Yes
No
If yes, what group?
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Please describe what steps you took acclimating your pet to your home.
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Have you ever given up a pet?
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Yes
No
Other
If yes or other, please explain the circumstances.
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Please provide the name and phone number of your past/current veterinarian or clinic:
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Do you give us permission to contact the veterinarian listed above to ensure your current/past pets are well taken care of?
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Yes
No
Please provide three references that we will contact before adopting the dog. Please provide their name, phone number, and relationship to you, please exclude household members.
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Your New Dog Information!!
Please describe what your ideal new adoptive family member would be like?
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What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)
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Reason for adopting
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Family Companion
Companion for Kids
Companion for Current Pet
Sport or Working Dog
Other
Are you open to adopting any of the following? (select all that apply)
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Special Needs
Medical Needs
Behavioral Needs
Not Housebroken
None of the Above
Other
Have you crate-trained a dog before? Do you plan on crating your new dog?
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Have you ever house-broken a dog or puppy before? Are you open to a dog/puppy who isn't fully housebroken?
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If the dog has an "accident" in your home, what type of correction do you plan to use?
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How many hours each day will your new pet be home alone?
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Where will your new dog stay when nobody is home?
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Are you willing to work through your new pet's issues, if any?
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Yes
No
To A Degree
How do you plan to work through any issues you are experiencing with your new pet? What are you not willing to work through?
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Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?
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Yes
No
Other
What is your plan for allowing your newly adopted pet to decompress?
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How do you plan to provide exercise and enrichment to your new pet?
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Do you understand that a dog can be an 18 year commitment, and can cost $300 - $1500 per year or more to care for?
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Yes
No
Do you understand emergency medical can come up at any time and cost up to $20,000 depending on the issue?
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Yes
No
Do you plan to take an obedience class with your dog or hire a trainer?
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Yes
No
Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for?
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What circumstances would lead you to give up your new dog?
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If you had to give up your dog, what would you do with him/her? Do you have someone who could take care of your dog if you were no longer able to?
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Are you ready for a 12-15 year commitment to the amazing dog you are applying for?
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How did you hear about us?
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Facebook
Instagram
Petfinder
Friend/Family Member
Adoption Event
Other
By signing this form, I/we acknowledge that the information on this form is true and correct. I/we agree to all provisions indicated on this form. I/we understand that any misrepresentation of fact may result in the rescue team refusing adoption privileges to me/us. If my/our request for adoption is approved and later our rescue team discovers the above information is not true or correct, this application becomes null and void. Because of my breach of contract, our rescue team reserves the right to remove the adopted pet from my home, and I will be held responsible for any associated legal costs incurred as part of said reclamation process. In order to ensure the best homes for our rescued pets, we reserve the right to deny any adoption application.
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Today's Date
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Month
-
Day
Year
Date
Submit
Submit
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