Adoption Application
Only dogs who are AVAILABLE for adoption are an option in the dropdown menu. If the dog you are interested in is not an option to select, we are NOT accepting applications for that dog at this time.
Which dog are you interested in adopting?
*
Lolly
Daisy
Have you ever adopted a dog from STRSE?
*
Yes
No
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
I understand STRSE is based in South Carolina and North Carolina and agree to make travel arrangements to the foster home to meet/pick up the dog I am interested in adopting.
*
I Agree
Select the type of housing you live in.
*
Single family home
Condo/Townhouse
Apartment
Dorm
Do you rent or own your home?
*
Own
Rent
If you rent, please provide name and phone number for landlord or property management company.
How long have you lived at this address?
*
Discuss your experience/opinions on training methods (including crate training).
*
What is the age range of the primary caregiver?
*
Under 21
21-25
26-31
36-40
41-50
50-60
60-70
70-75
76+
Are there any minor children living at home or will the dog come in contact with minor children?
*
Yes, minor children live in the home
No, no minor children live in or visit the home
No minor children live in the home, but our dog will be in contact with minor children that visit.
If yes, please list ALL ages of minor(s)
Is your yard securely fenced?
*
Yes
No
If yes, describe your fence type, size, etc.
Is there a pool or any other body of water on your property?
*
Yes
No
Do you currently own ANY other pets?
*
Yes
No
If yes, please list all pets that you own. Please include type, breed, sex, age, spay/neutered.
Where will the dog stay during the day?
*
Where will the dog sleep at night?
*
Who cares for your pets when you're out of town?
*
Have you ever surrendered any pets to a rescue or other shelter (humane society, animal control, etc.)
*
Yes
No
If yes, please explain
List any pets that you have owned in the last 10 years but no longer do.
*
Any other information you would like to share?
If you are completing this application on behalf of someone else, please explain the circumstances.
Vet's Name (current or intended)
*
Vet's Address
*
Vet's Phone Number
*
Electronic SignatureI affirm that all information contained in the application is true and correct. I have discussed this plan with other family members and we all understand the time, energy, and financial obligations involved with the decision to adopt a rescue, Scottie. I also understand that I may be asked to make a donation and/or pay an adoption fee to help defray medical and other expenses associated with running the rescue program. I agree you may contact my veterinary reference. MY TYPED SIGNATURE BELOW INDICATES MY FULL UNDERSTANDING OF THE ABOVE STATEMENT AND THE ACCURACY OF ALL INFORMATION CONTAINED IN THIS APPLICATION.
*
Date
*
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: