Dog Adoption Application

Dog Adoption Application

This application helps us get to know you and be sure the dog you’re interested in is a good fit. Your information will stay private and only be shared with Senior Dogs Rock and the dog’s current owner.
Name of dog you are interested in adopting:
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Primary Email Address*
example@example.com
Secondary Email Address
example@example.com
Do you own or rent?*

OwnRent
If you own, please list the name(s) on the deed
Housing Type*
If you rent, are you allowed to have pets?

YesNo
Please provide the name and phone number of your landlord for pet policy verification.
What’s the general activity/noise level in your home (for example: very quiet, moderate, frequently active)?*
Occupation and hours worked outside the home*
Where will the dog be primarily kept?*
How soon are you ready to adopt?*
Do you agree to a home visit as part of this application process (either in person or virtually)?*

YesNo
Please list the names and ages of all other household members and their relationship to you*
Please list any pets you have owned in the past five years, including how long you had them and their current status (still with you, passed, or rehomed).*
Have you ever had to rehome a pet? If yes, please tell us why and where the pet went.*
Are your current pets spayed/neutered, up to date on vaccinations, and on heartworm prevention? If not, that’s okay — just let us know why.*
Please provide the name and phone number of your current veterinarian, as well as the name listed on your pet’s records. Be sure to contact your vet beforehand and grant permission for them to speak with us.*
Do you have a yard and is it fenced in?*

YesNo
Are your windows secured with screens or other safety measures to prevent pets from escaping?*

YesNo
Who will be the primary caregiver for this dog?*
Do you or anyone in the household have pet allergies?*

YesNo
On average, how many hours per day will the dog be alone? What arrangements will you make when you’re at work or out?*
Where will your dog be kept when alone? (for example, in a crate, allowed to roam indoors, in a fenced yard, or outdoors)*
Where will the dog sleep?*
Where will your dog stay while you are on vacation?*
How do you plan on exercising your new dog?*
Do you have any experience with this breed? Are you familiar with common issues?*
Can you describe any obedience training or past experience with behavioral or medical issues?*
What methods will you use to housebreak your new dog, if they are not already housebroken?*
What methods will you use for obedience training?*
Are you willing to work through unexpected hardships with your dog (i.e. housetraining, marking in the house, separation anxiety, fear, socialization, etc.)?*

YesNo
Are you able to commit the time and resources needed for veterinary care or professional training if your dog requires it?*

YesNo
Are you familiar with the 3-3-3 rule for rescue dogs?*

YesNo
Will there be any major life changes in the next year (for example, moving, getting married, expanding your family through birth or adoption, or other significant changes)? If yes, please describe.*
Please provide at least two personal references (non-family members) and their phone numbers, and let them know that someone may be contacting them:*
Anything else you would like us to know?
Do you have any concerns about adopting?
What made you want to apply for this dog and why do you think they might be a good match for your household?
How did you hear about this dog?
Should be Empty: