DSR Adoption Application

DSR Adoption Application

Doggy Smiles Rescue
Adoption Application
Name of the animal you are interested in:
Why do you want to adopt this animal?
Personal Information
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*
Please enter a valid phone number. (required)
Home Phone
Optional
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Dog Information
Please describe the way(s) in which, and how often, you will exercise your animal:*
Most of our dogs need a refresher on housebreaking. If behavioral issues arise, how do you plan to address them?*
What animal behaviors or life circumstances would make you feel you could not keep the animal (e.g., aggression, divorce, job loss, move, children, etc.)*
Who will take care of the dog when you leave town?*
How many hours will the dog be left alone during the weekday:*
Where will the dog be kept: during the day*
During the night, we require dogs to come inside.*

I Acknowledge and AgreeI Do Not Agree
Veterinarian Information
Name of your Veterinarian
Where you plan to take your new pet
Phone Number
Please enter a valid phone number.

Sign and Agreement

By signing below, you attest the following are true.

I, and no one in my current household, have ever been convicted of any form of animal abuse, neglect, or abandonment.
By signing this agreement, I consent to Doggy Smiles Rescue’s approval process, which may include, a home visit, and meeting other members of your household..
I acknowledge an adoption fee is a donation and is not refundable, if the dog is returned.
I understand that Doggy Smiles Rescue's adoption process is to find what we believe will be the best environment for each particular dog.
Signature*

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Date*

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Date
Name*

First NameLast Name
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