Summit Dog Rescue Adoption Application

Application for Canine Guardianship

Applicant's General Information
Full Name of Applicant*
E-mail*
example@example.com
Phone Number*
Occupation/Employer:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Co-Applicant (Spouse, significant other, roommate), if applicable:
Co-Applicant's Email, if applicable:
example@example.com
Co-Applicant's Occupation/Employer, if applicable:

Please list all pets in your household. Include both current AND past. *

	Name	Species & Breed	Age	Gender	Spay/ Neuter?	Temperament	Residing with you?
.
.
.
.

For any pet no longer residing with you, please tell us why the pet is no longer in your home:

Please list all the people in your household. . *

	Name	Age
Self
Person #2
Person #3
Person #4
Person #5

Is everyone in the household on board with adopting a new dog?*

Is everyone in the household on board with adopting a new dog? Please note each person’s level of commitment to the new dog using the following 1-to-5 scale: 0 indicates “don’t want a new dog in the house,” 1 indicates “I will be ok with having a new dog in the house but do not intend to be responsible for his/her care”; 5 indicates “I am excited about adding a new dog to the home and look forward to being responsible for his happiness, training, and wellbeing.”

	1	2	3	4	5
Self
Person #2
Person #3
Person #4
Person #5

Do you have your heart set on one specific 12:10 dog? If so, who is that? It helps us to know whether you are only applying for a particular dog or are flexible in your options.*

Your Environment
Urban, suburban, or rural?*
Do you own or rent? Is this a house, condo or apartment?*
If rent, include property owner's name, phone number, address, and email.
If rent, some landlords have dog restrictions based on breed and size. Is the dog you are interested in allowed at your residence?
How long have you resided at this location?*
Do you have a fenced yard? (answer YES or NO).*
If you do have a fence, please describe: height, material, approximate size of enclosure:
Please describe approximately how many hours your dog will be left alone daily, and where your dog will be when left alone:*
If you need to relocate, how will your dog fit into that plan?*

Dog Characteristics
The following questions are to help us ensure the dog you are interested in is a good fit for you. There are no right or wrong answers, so please be as honest and accurate as possible.
Why do you want a dog?
What physical and personality characteristics are you looking for in a dog (e.g., low-shedding, male/female, energy level, a training project or more of a stable dog with lots of history)?*
12:10 K9 Rescue dogs are of indeterminate origin from shelters, individuals, and organizations throughout the Michigan. We made an educated guess as to what breeds they may be, and we do not make any guarantees as to their breeding or that their temperament will resemble that of the breed they resemble.
Describe how your dog will be exercised daily i.e. a few blocks during the week, playing fetch in your yard, daily hiking on trails on leash, hiking off leash, long walks in neighborhood park, weekend hikes:*
Do you regularly have children or other guests visit your home? How often do children visit specifically? Will your dog be exposed to children on a regular basis (in parks, playground, home settings).
Do you foresee any major life changes over the next two years? (e.g., promotion/transfer at work, military deployment, relationship change such as marriage, remodeling your home or yard, having children)

Training & Behavior
The first few weeks or months after bringing a dog into your home can be the most challenging - and the most important. Your dog has likely experienced multiple transitions already, and arriving at your home is yet another big change in their world. As a result, you may notice new behaviors emerge or existing ones become more intense during this adjustment period. Adoption requires patience, flexibility, and a willingness to work through these early challenges as your dog learns to feel safe and secure.
Have you ever had a dog with behavior problems? If so what behavior(s) and how did you work with your dog on this issue?
If you are approved to adopt from 12:10, you will be required to complete 8 hours of free in-person training for dog handling skills with us. Is this agreeable?*
How would you handle behavioral challenges if they arise after adoption? Please describe any strategies, resources, or support systems you would use to help your dog adjust and improve.*
Have you worked with a professional trainer? If so, what is your trainers name?*
Please refer to our website and read more about adjustment periods for newly-adopted rescue dogs.
Please identify behaviors you would NOT be willing to work with:*
(e.g., growling at strangers, Lunging on leash at other dogs, nipping children, separation anxiety, leash pulling, housetraining accidents, counter surfing, other)

How important is it to you to modify any behavioral challenges the dog may have? Please give a number between 1 and 10 based on the following criteria: 1 is “I will find time to work with my dog twice a week for 5 to 10 minutes”; 10 is “I will make significant changes in my own behavior in order to help modify my dog’s(s) behavior.” Each adult who is involved with the dog(s) should answer this question.*

	Training Commitment
Self
Person #2
Person #3
Person #4
Person #5

Please list the TOP THREE most important behaviors that you would like to see reasonably quickly in your newly adopted dog (i.e. friendly with kids, good with cats, easy to walk on leash, housetrained, okay alone in the house, crate trained, quiet, food-motivated, okay with loud noises etc): *
Under what circumstances would you consider returning your adopted dog? Please think through this answer carefully, i.e. nipped my child, attacked my cat, bit a family member, etc.:*

Questions Regarding Vet Care
Who is your veterinarian? *
What is your veterinarian's phone number?*

Almost Done!
Have you ever lived with a dog from a rescue organization or shelter?*
What is your timeframe for adopting?*

Ready and eager for a dog this week; actively looking at shelters and surfing the internetApplying with multiple rescues; hoping for the right match in the next few weeksHappy to wait a few months for the right fitI am only applying for one specific dog, and if I don't get him/her I will look no further
Do you agree to contact 12:10 K9 Rescue if after adoption you are unable to continue to be a guardian for your adopted dog, and either return your dog to us or work with us to find another suitable home for your dog? Please answer YES or NO.*
Do you agree to read to the short book "Love Them By Leading Them, The Good Dog Way" by Sean O BEFORE your home visit is conducted?*

YesNoMaybe
Please list two personal references (not a household member), including name, relationship to you, phone, and email:
Reference #1; Name, Relationship, Phone, Email*
Reference #2; Name, Relationship, Phone, Email*
Reference #3; Name, Relationship, Phone, Email*
The complete 12:10 K9 Rescue adoption process includes a phone interview, personal reference check, vet reference check, meet and greet, and a home visit. Submission of this application confirms that you understand and agree to the need for screening of adopters and certify that the information supplied on this application is true and correct. The terms “guardian” and “owner” shall be considered interchangeable. Please initial here that all your responses are truthful and complete.*
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Application for Canine Guardianship