DOG ADOPTION APPLICATION
This form and a consultation with an EDR&R representative are designed to help you find the dog most compatible with your lifestyle. Completion of this application does not guarantee adoption of an EDR&R dog. Please respond to the questions below as completely as possible.
In order to be considered as an adopter you must:
1. Be 21 years of age or older 2. Have a valid driver's license or other government-issued ID 3. Have the knowledge and consent of your landlord if renting 4. Be willing and able to provide proper care, training and medical treatment for the life of the animal you adopt
Name:
First Name
Last Name
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home phone:
Format: (000) 000-0000.
Cell phone:
Format: (000) 000-0000.
Work phone:
Format: (000) 000-0000.
Email address:
example@example.com
Occupation:
Employer:
Employer Address:
Number of Adults in Household.
Number of Children
Ages of Children
Are all the adults in your household aware that you are adopting a dog and in agreement?
Yes
no
Is there a particular dog you are interested in adopting? If so, list name and breed:
Who will be the primary caregiver for your new dog?
Is any member of the household allergic to dogs?
What type of housing do you live in?
house
apartment
condo
other
Do you own or rent?
Landlord's name & phone#
Do you have a completely fenced yard?
What kind of fence?
Height :
Gate?
Do you have a pool?
If yes, is it fenced?
Why do you want a dog?
What qualities are you looking for in your new dog?
Back
Next
Which of the following behaviors would be a serious problem for you?
Excessive barking
digging
jumping a fence
not getting along with cats
not getting along with other dogs
not good with children
not housetrained
too active
not playful with other animals
not playful with children
not good with being left alone
difficult to walk on a leash
too big
too much shedding
Other
How many hours each day will the dog be left alone?
Where will the dog be kept when alone?
Where will the dog be when you are home?
Where will the dog sleep at night?
Are there times when the dog will be tied outside? If yes, when?
How often and what type of exercise will you give your dog?
Are you looking for a dog to participate in any other activties (scent work, hunting, agility, etc)? If so, please list/describe:
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Next
Is this your first dog?
yes
no
If you presently have a companion animal(s), please complete:
Rows
Name
Breed
Age
Gender
Spayed/ neutered?
Current on vaccines?
1
2
3
4
If you have previously had a companion animal(s), please complete:
Rows
Name
Breed
Years owned
What happened?
1
2
3
4
5
Name of your veterinarian
First Name
Last Name
City/Town
Have you ever turned a pet into a shelter?
If yes, explain
Are you planning to attend obedience classes with your new dog?
If your new dog is not housebroken, how will you correct him/her when there is an accident, and what method will you use to train him/her?
How long do you expect housetraining to take?
When you go on vacation/travel, who will care for the dog?
How much are you willing to spend on medical bills for your dog?
What would you do if the bills go over this amount?
Are you ready to take responsibility for this dog/puppy for the next 10-15 years?
What provisions will you make for the dog should you become unable to care for it ?
Have you previously applied to adopt a dog or cat from EDR&R?
If yes, when?
Explain:
Are you willing to have a representative of EDR&R visit where the dog will be living?
Interviewer Approval:
Date (Interviewer Approval)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Interviewer APproval:
Date (Interviewer APproval 2)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
I certify that the information above is true and understand that false information will result in nullification of this adoption.
Prospective Adopter Signature:
Date (Prospective Adopter)
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Preview PDF
Submit
Should be Empty: