Dog Adoption App

Dog/Cat Adoption Application
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long at this address?:*
Are you planning on moving within the next 6 months?*

YesNo
If yes, what are your plans for your pets if you move?
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Name of Employer:
Work Phone Number

Area CodePhone Number
Up until what time of night can we contact you via phone?*
E-mail*
Are you 18 years of age or older?*

YesNo
Birth Date*

MonthDayYear
Do you own your own home?*

YesNo
If no, name and phone # of landlord:
Type of Dwelling:*
Name and age of ALL occupants in household (including yourself):*
If no children, do you plan on having children or will children be visiting the household frequently?*

YesNo
What is your reason for wanting to adopt a dog?*

HousepetCompanionCompanion for petGiftGuard DogOther
If other, please explain:
How many total hours will your new pet be left alone during the day?*
How many total hours will your new dog be outside alone during the day?*
If adopting a puppy, where would the puppy be kept when alone?
Do you have a fenced yard?*

YesNo
If yes, which type of fence?*

WoodChain LinkSplit RailN/A
If yes, how tall is your fence?:*
Do you have locks and/or latches on all your gates?*

YesNoN/A
Will your adopted dog or do your current dogs be put on a tie out?*

YesNoNot sure
Are any members of your household allergic to animals?*

YesNo
If yes, please describe:
Who will have chief responsibility for the care of your new pet?*
Over the past 5 years, how many pets have you owned? (Include current pets)*
List each individually including breed, age, still living with you? (if not, why?)
Have you and your spouse (if applicable) ever owned a pet together?*

YesNoN/A
If yes, when?
Have you ever lost or given away a pet?*

YesNo
If you currently own a dog or cat, how does he/she react to new pets?
Are your present pets up-to-date on their annual vaccines?*

YesNoN/A
If no, please explain:
Are your present pets spayed or neutered?*

YesNoN/A
If no, please explain.
Were your previous pets spayed or neutered?*

YesNoN/A
If no, please explain.
How much are you financially prepared to spend for routine/emergency medical care, licensing, etc?*
What plans do you have for your new pet when you are on vacation?*
Which dog(s) are you interested in?*
Age of cat you would consider adopting: (check all that apply)*

PuppyYoungAdultSpecial NeedsSeniorBonded Pair
Can/Will you provide your dog with monthly heart worm/flea/tick prevention?*

YesNo
Who is your current or most recent veterinarian? Please provide their NAME and PHONE NUMBER:*
If your dog displays behavioral problems (such as jumping on people,excessive barking, potty accidents, etc.) how would you go about correcting the behavior?*

Contact a ProfessionalUse a bookPersonal KnowledgeOther
If other, please explain:
What type of solution would you be willing to try if housebreaking accidents continue after the first week (check all that apply)?*

Try crate trainingUse positive enforcementUse potty padsHave dog examined by vetUse a dog doorReturn dogNoneOther
If other, please explain:
Is your entire immediate family in agreement with the decision to bring a new pet into your home?*

YesNo
If anyone is NOT, please explain:
Are you prepared to commit to a pet for 15 - 20 years (average life span)?*

YesNo
Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?*

YesNo
If yes, please describe:
Have you ever adopted or tried to adopt a pet from us before? If yes, fill out info below.*

YesNo
Pet’s Information

Pet’s NameCat or Dog?Adoption/Application Date
Where will your dog spend most of his/her time?*
If you selected outdoor, would your dog be supervised?

YesNo
Where will your dog eat?*
Where will your dog sleep?*
Please provide 2 personal references (only 1 can be a relative) that can testify to your responsibility and ability to care for your animals. This is required or your application cannot be approved.
Reference #1*
First and Last Name & Relationship to Self
Reference # 1 Phone Number*

Area CodePhone Number
Reference #2*
First and Last Name & Relationship to Self
Reference #2 Phone Number*

Area CodePhone Number
If there is anything else you think we should know, please note it here.
Please remember, it may take approximately 2 to 3 business days for us to get back to you.
Thank you so much for wanting to rescue a dog!!
Should be Empty:

Dog/Cat Adoption Application

Please provide 2 personal references (only 1 can be a relative) that can testify to your responsibility and ability to care for your animals. This is required or your application cannot be approved.

Please remember, it may take approximately 2 to 3 business days for us to get back to you.

Thank you so much for wanting to rescue a dog!!