Adoption Application
ONE APPLICATION SUBMISSION WORKS FOR ALL CURRENT/FUTURE DOGS. If you have submitted an adoption app to JDR previously, there is no need to fill out again-- please contact JDR if you see a dog listed that you're interested in.
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Phone Number- secondary (if applicable)
Please enter a valid phone number.
Age
*
Occupation
*
If retired, type retired
Home type
*
Please Select
Home (own)
Home (rent)
Apartment
multi-family dwelling
Landlord contact information, if applicable
Agree to a home visit?
*
Yes
No
Agree to video "visit"?
*
Yes
No
Please describe your home/ property.
*
Please describe yourself/the applicant
*
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Next
References
Reference 1
*
First Name
Last Name
Reference 1 phone number
*
Please enter a valid phone number.
How do you know this reference?
*
Reference 2
*
First Name
Last Name
Reference 2 Phone Number
*
Please enter a valid phone number.
How do you know this 2nd reference?
*
Reference 3
First Name
Last Name
Reference 3 Phone Number
Please enter a valid phone number.
How do you know this 3rd reference?
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Next
Pet Ownership Information
Prior or present dog ownership? If yes, you must fill out the form below
*
Yes
No
Current Pets
Current pet name:
Current pet 1
Breed/type
current pet 1
Describe current pet 1: Age, sex, time of ownership, pet origination:
Current pet 1
Is this pet on heartworm treatment?
Yes
No
Is this pet fixed?
Yes- spayed or neutered
No- currently intact
Current pet 2 (if applicable)- Name
Current pet 2
Breed/type:
Current pet 2
Describe current pet 2: Age, sex, time of ownership, pet origination:
Current pet 2
Is this pet on heartworm treatment?
Yes
No
Is this pet fixed?
Yes- spayed/neutered
No- still intact
If you have other pets, please add in their information (like above) here. Please include name, type/breed, age, time of ownership, if on heartworm treatment, and if the pet(s) is/are fixed or still intact:
Prior pet ownership: What other pets have you owned in the last 5 years? Please give details below. What kind of pet(s)? What happened to them, or where are they now?
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Next
Veterinarian Information
Where do you have your pet(s) vaccinated?
*
local veterinarian
local vaccination clinics
We do not vaccinate
We are first time pet owners so do not have an established vet yet
Current Veterinarian
*
If first time pet owners, type N/A
Veterinarian phone number
Please enter a valid phone number.
If secondary vet, please include information here:
Any additional residents within your home?
Are there additional residents (other than you) in your home? (If so, please list below)
*
Yes
No
Additional resident (other than you) within your home:
Name, resident 1
Age
Resident 1
Occupation
Resident 1
Additional resident within your home:
Name, resident 2
Age
Resident 2
Occupation
Resident 2
Additional resident within your home:
Name, resident 3
Age
Resident 3
Occupation
Resident 3
If any more residents in your home, other than those listed above, please include their name, age and occupation below:
Will any of these residents be a co-adopter?
*
Yes- resident 1
Yes- resident 2
Yes- resident 3
No co-adopter
Other
Contact phone number for co-adopter, if applicable:
Questionnaire
Why do you want to adopt a new dog?
*
How soon are you able to adopt? When will you be ready?
*
Under what circumstances would you give up a pet?
*
Are you willing to travel to meet your new dog?
*
Yes- any distance within NJ
Yes- but very limited distance
No I will not travel
Where will the dog reside when are you at home?
*
Where will the dog reside when you are NOT home? (Ex: Inside, outside, in crate, free-roaming, etc)
*
How will you provide socialization for the dog?
*
How many hours, approximately, will the dog be left alone daily?
*
Training
Do you plan on using a professional trainer?
*
Have you ever used a professional trainer for a prior pet?
*
Are you willing to take your new dog to obedience classes?
*
Yes
No
Adoption preferences
Preferred age of dog: (check as many as apply)
*
Puppy (0-6 months)
6 months- 1 year
1-3 years
3-5 years
5 years or above
No preference
Preferred characteristics of your new dog:
Preferred sex of dog:
*
Male
Female
No preference
Are you interested in a specific dog from our site?
At JDR, we love to play matchmaker! We try to find the best fit for both YOU/your family AND the dogs in our care! If this specific dog is unavailable, would you like us to contact you about other dog(s) that may be a good fit for you? (check all that apply)
*
Yes- contact me regardless. I am open to other dogs as well
No- I am only interested in this specific dog- contact me only if this dog is available
I might like to discuss other dogs
I have preferences for breed, sex, size etc...I'd like you to help me find something specific that matches my needs
Is there any more information that you want us to know about you? Please feel free to put any information that may help us learn more about you!
All information provided above is considered confidential and only to be used in the adoption process. Your information is not sold, shared, or distributed to third parties. If you request, we may forward your information/application to another rescue organization- which you must state to JDR via email. By submitting this application, you acknowledge that you are over the age of 21, all information contained therein is true/accurate, you have the financial means to take care of your future dog. Additionally this application does not guarantee approval and/or adoption. Do you understand and agree?
*
Yes
No
By typing your name below, you confirm the information contained herein is accurate and true, and this will count in lieu of a signature.
Type full name here
Today's date:
-
Month
-
Day
Year
Date
Submit
Should be Empty: