Dog Adoption Application
Application must be filled out completely to be considered.
Dog You Are Applying For:
*
Date of Submission:
*
What date will you be ready to complete an adoption and take a dog home? Make sure to take upcoming trips into account.
*
Have you already met this dog in person?
*
Yes
No
Have you spoken to anyone from our organization about this dog yet? If so, please tell us your point of contact:
*
Do you understand that we require all pets currently in your home to be up to date on veterinary care and spayed/neutered in order to qualify for adoption?
*
Yes
No
Applicant Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City, State, Zip Code
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail Address:
*
example@example.com
Home Phone:
*
Format: (000) 000-0000.
Cell
Other:
Pet Information: Please list any pets you have had in the last five years. If the pet is deceased, please list their age at the time of their passing.
Rows
Name of pet
Breed
Age of pet
Gender
Spayed/ Neutered?
Is (or was) this pet on Heartworm Prevention?
Do you still have this pet?
1
2
3
4
5
Veterinary practice(s) pets are seen at:
Vet office phone number:
Format: (000) 000-0000.
What human name(s) are your pet's records under at the vet's office?
About Your Home
Check your type of dwelling:
*
House
Townhouse
Condo
Apartment
Other
Do you own or rent?
*
Own
Rent*
* If you are a renter, written permission from your property owner is required.
How long have you lived at your current residence?
*
Do you have a fully fenced in yard with 4 sides?
*
Yes
No
If so, type of fencing:
Chain Link
Privacy
Underground
Other:
Fence Height:
How many adults are in your household?
*
# of children:
*
Children's age(s):
Who will be the dog's primary caretaker (i.e. feeding, training, exercise, grooming, etc.)?
Employment Information
Employer:
*
Position:
*
How long have you been with this employer?
*
Privacy notice: The information you provide will be shared only with our volunteers, for the purpose of ensuring a positive match.
Stepping Stones Canine Rescue / steppingstonesrescue@gmail.com (Page 1 of 3)
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References - Please list two references. This can include one family member, but the other should be a non-family member.
Rows
Name
Relationship
Phone Number
1
2
This pet will be:
*
outside
inside/outside
inside (main living area)
other
During the day, this pet will be kept in:
*
crate
inside
outside
chained out
other
At night, this pet will be kept in:
*
crate
inside
outside
other
Why do you want to adopt?
*
How long have you been looking for a new companion?
*
What attracted you to this particular animal?
*
How much time will the new dog spend alone in a 24 hr period?
*
How will you exercise a new dog?
*
How much do you think it will cost to feed, care for and vaccinate this pet annually?
*
Are you familiar with and do you plan to put this pet on Heartworm Prevention?
*
How much time are you willing to give your pet to adjust to his/her new home?
*
If you move, change jobs or have a lifestyle change, what will you do with this pet?
*
Do you have any upcoming trips or travel within the next month?
*
Yes
No
If yes, what will you do with this pet?
Have you ever taken a pet to the Animal Shelter or have your pets ever been picked up by Animal Control?
*
Yes
No
If yes, please explain :
Have you ever surrendered a pet or rehomed a pet?
*
Yes
No
If yes, please explain :
Please feel free to provide us with additional information that will help in evaluating your application. Please remember that this application is how we get to know you and how we identify potential matches for our adoptive dogs.
Privacy notice: The information you provide will be shared only with our volunteers, for the purpose of ensuring a positive match. Stepping Stones Canine Rescue / steppingstonesrescue@gmail.com (Page 2 of 3)
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Pet Adoption Application
Application must be filled out completely to be considered.
Stepping Stones Canine Rescue is committed to rescuing a variety of breeds, ages and types of dogs from the local animal shelter. We continually rescue dogs, provide proper medical attention and find a loving, forever home for each of them. We are also committed to the education of pet care in our community, including awareness and importance of spay/neuter.
By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application. I understand that this application is the property of
Stepping Stones
. I understand that
Stepping Stones
reserves the right to deny my application for any reason.
Our utmost concern is matching pet to owner ensuring a successful union to last a lifetime. We require one home visit with the dog prior to the adoption and one home visit, at our request, after the adoption. If at any time, should the dog be, in our opinion, neglected, malnourished or lacking in the proper care you must agree to relinquish the dog to us on demand. If for any reason you cannot keep the dog, you must notify us to retum the dog. By signing this application, you agree to all terms of this contract.
Once adopted, it is required that each dog/puppy is examined by a veterinarian as soon as possible so the dog can be given a thorough physical exam. The adopter also contracts that he/she will alter (spay/neuter) the dog at six (6) months of age if adopted before this time. Proof of spay/neuter is required.
Signature
Name:
*
Date:
*
-
Month
-
Day
Year
Date
Privacy notice: The information you provide will be shared only with our volunteers, for the purpose of ensuring a positive match. Stepping Stones Canine Rescue/steppingstonesrescue@gmail.com (Page 3 of 3)
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