Dog Adoption Application

Name of dog you are interested in adopting:

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Primary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Secondary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Primary Email Address

example@example.com

Secondary Email Address

example@example.com

Do you own or rent?

If you own, please list the name(s) on the deed

Housing Type

If you rent, are you allowed to have pets?

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)?

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 ten years, including how long you had them and their current status (still with you, passed, or rehomed). If you currently have dogs, please include their breed and age.

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?

Who will be the primary caregiver for this dog?

Do you or anyone in the household have pet allergies?

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.)?

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

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

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?

Senior Dogs Rock Role, Acknowledgment and Release

Senior Dogs Rock provides rehoming assistance to pet owners and is not a rescue, shelter, owner, seller or custodian of the dog. Information provided regarding a dog's health, medical history, temperament, behavior, bite history or other characteristics is based primarily on information supplied by the dog's current owner or other third parties.

Senior Dogs Rock does not independently evaluate the dog and cannot verify or guarantee the accuracy or completeness of this information. Senior Dogs Rock may review applications, check references and facilitate communication between an applicant and the dog's owner. This assistance does not constitute a guarantee or representation that a particular dog is suitable for an applicant or household. The decision to proceed with an adoption and the transfer of the dog are solely between the dog's legal owner and the adopter.

I understand that adopting or taking possession of a dog involves risks, including the possibility of previously unknown or undisclosed medical conditions or behavioral issues and the possibility that a dog's behavior may change in a new environment. I understand that Senior Dogs Rock cannot predict or guarantee a dog's future health or behavior. I am responsible for conducting my own evaluation of the dog, asking the owner any questions I consider important and deciding whether to proceed.

To the fullest extent permitted by applicable law, I voluntarily assume the risks associated with my decision to adopt or take possession of the dog and agree to release and hold harmless Senior Dogs Rock and the individual providing assistance through Senior Dogs Rock from claims, losses, expenses or damages arising from or related to the dog's health, behavior or actions, including undisclosed or inaccurate information provided by the dog's owner or other third parties, bites or other injuries, property damage, veterinary or training expenses, or an adoption that does not work out.

By signing below, I acknowledge that I have read and understand this statement, including that I am voluntarily giving up the right to bring claims against Senior Dogs Rock and the individual providing assistance through Senior Dogs Rock for the matters described above, to the fullest extent permitted by applicable law.