Adoption Application for Wheels4Paws

Wheels 4 Paws 4 Ever Homes, INC

P.O Box 313

Cordova, NC 28330

910-995-0303

Adoption Application

Thank you for your interest in adopting a dog/puppy from Wheels 4 Paws 4 Ever Homes, Inc. We are an organization that rescues dogs from high-kill shelters and underwrite the cost of placing them into our Organization, where they are vetted. Most of these dogs have ended up in kill shelters through no fault of their own- some are owner surrenders from people that have lost their homes or are no longer able to care for them, many of them were simply born into an area where there are major over-population problems. However, some of these dogs have never been in a home at all, so it is important to know what we expect from you as a potential adopter.

Dogs are extremely intelligent animals. As such, they need firm, consistent leadership, even from when they are a puppy. Dogs need to have a structured environment in which they can learn to follow a schedule. You are making a decade long (possibly longer) commitment by adopting a dog/puppy. If a behavioral problem arises, we expect you to exhaust all possible solutions, including, but not limited to, consulting a professional trainer or behaviorist to resolve the issue. Sometimes problems that arise can be taken care of with just one or two sessions with a good trainer. We desperately want to rescue as many animals as possible, therefore we seek adopters that are willing to be responsible and fully committed owners who are not just making a quick decision to adopt a cute puppy. Some possible challenging behaviors that can occur in all dogs, whether purchased from a breeder or rescued from a shelter include (but are not limited to) chewing/biting/barking, housebreaking issues, problems walking on a leash, and shyness/nervousness around strangers. There are many other issues that can arise with ownership of any dog, and our potential adopters should be prepared to deal with these.

Again, thank you for your interest in rescuing one of our wonderful dogs/puppies. Please be fully committed to being a dog owner in good times and challenging ones. If you are ready and willing to make this commitment, then we welcome you to our W4P family.

Please fill in spaces and check boxes

Date:*

MonthDayYear

Full Name*

First NameLast Name

Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number*

Area CodePhone Number

Work Phone Number*

Area CodePhone Number

Cell Phone Number*

Area CodePhone Number

E-mail*

Alternate E-mail

Name of Employer (enter retired, unemployed etc if different)*

What is your current job title?*

Employers Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Employed since? *

MonthDayYear

What is your date of birth? (We DO NOT adopt to persons under 21 years of age):*

MonthDayYear

Please list all members of your household other than yourself, please include their relationship to you and their ages:*

Does any member of the family have any allergies to animals?*

YesNo

Please provide details if allergies are a consideration:

Do you have other pets? Please specify type of pet, name, age, and gender:

Are these pets spayed/neutered?

YesNo

Are the current pets up to date on vaccines?

YesNo

Have you researched the breed of dog you are looking to adopt?*

YesNo

If you are not applying for a specific dog, please describe the breed/age of dog you are looking to adopt.*

Where did you learn about Wheels 4 Paws Rescue?*

Why are you interested in adopting a dog from W4P?*

Vets Name:*

Vets Phone Number:*

Area CodePhone Number

Vets Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Please provide any additional information you feel we should know about your current pets:

Are you willing and able to accept financial responsibility for the expenses associated with caring for a dog including preventative health care including annual check-up as well as emergency medical care in the event of illness or injury in addition to cost of regular care and feeding (food, supplies and equipment, toys, training and boarding)? Please explain: *

Were these previous pets spayed/neutered and up to date on vaccines?

YesNo

Please list any other information about these pets you wish for us to know.

What type of home do you live in (apartment, duplex, single family house, etc)? *

Single Family HomeDuplexApartment

Do you own or rent?*

OwnRent

If renting, please enter your landlord's name and phone number (required if you are renting):

If you rent, have you received the approval of your landlord to have an animal (required if you are renting)?

YesNo

If you own your home, does your HOA have any restrictions on the number of dogs or the type of dogs a home owner can have?

YesNo

Do you have a fenced in yard? *

YesNo

If so, what is the approximate height of the fence at the lowest point?

What type of fence?

Is the fence attached to the house?

YesNo

Do you have a pool or any other additions to your yard that could be a potential danger to an animal? *

Do you plan on moving any time in the near future?*

YesNo

Do you consider pets to ensure part of your family?*

YesNo

How much time are you prepared to allow for your new pet to adjust to your home? *

Are you willing to properly train your dog? *

YesNo

Are you willing to take the time to housebreak a dog, and do you understand that changing a dog’s environment may cause the dog to have accidents? In addition, some shelter dogs have never lived inside and will have no potty training experience, is this something you are willing to work with your new dog through?*

YesNo

If a behavioral problem arises, what steps will you take to work on it?*

How often will you exercise the dog and for approximately how long?*

Who will be responsible for feeding and taking the dog outside? *

Will you allow the dog to run loose? If yes, where and under what conditions? *

Who will take care of the dog in your absence? *

How much time will the animal spend alone during the day?*

Where will the dog be kept when you are not home?*

Where will the dog stay when you are home? *

Where will the dog sleep? *

Are you willing and able to accept financial responsibility for the expenses associated with caring for a dog including preventative health care including annual check-up and vaccinations as well as emergency medical care in the event of illness or injury in addition to cost of regular care and feeding (food, supplies and equipment, toys, training and boarding)? Please explain:*

Are you willing and able to take care of this dog for all of its natural life?*

YesNo

Under what circumstances would you return a dog? *

If, for some reason, you are unable to care for this dog, what will you do with it? *

Have you ever had to return or surrender a dog in the past? If yes, explain the circumstances.*

YesNo

Explain why you returned or surrendered a dog in the past:

Are you aware of the adoption fee ($250 nonrefundable donation for dogs over 6 months/$350 nonrefundable donation for dogs under 6 months)?*

YesNo

Would you object to an W4P representative visiting your dog in their new home? *

YesNo

The adopter accepts that the dog may have a medical condition of which W4P, Inc is unaware, and therefore W4P, Inc is not liable for medical expenses.*

I agree

Please provide a personal reference (must be someone other than a family member and not living with you), include name, phone # and their relationship to you.

Personal References Number 1-NAME:*

Relationship:*

Years known? *

Their Phone Number:*

Area CodePhone Number

Personal Reference Number 2-NAME:*

Relationship:*

Years known? *

Their Phone Number:*

Area CodePhone Number

I, undersigned, agree to the following statements: The information I provide will be verified before I am approved for adoption. False statements or omissions of any of the above information will result in automatic refusal of adoption or confiscation of the adopted animal. W4P has the right to refuse the adoption of any pet to any person. The adoption fee is non-refundable.*

I agree

Signature:*

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