DOG Adoption Application-Imagine Peace for Pups

DOG Adoption Application Imagine Peace for Pups Rescue, Inc.
Date*

MonthDayYear
Full Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer, phone, address*
Which dog are you interested in?*
Where did you hear about this dog*

FacebookPetfinderFriendRescue RepresentativeOther
Please indicate reasons for wanting to adopt this dog*

Family PetCompanionWatch dogOther
Do you live in a*

HouseApartmentCondoManufactured Home
Do you*

OwnRent
Does your rental agreement allow pets*

yesI don't knowconditionalOwner
what are the restrictions*
may we contact your landlord*

yesnoOwner
If renter, name of Landlord
Phone Number

Area CodePhone Number
Do you have a secure fenced yard

yesno
How long have you resided at this address
Please check all that apply*

Busy household - children in and out a lot - visits by friendsNoisy - loud TV, music, children playing, barking dogs, machineryModerate - normal coming and goingQuiet - homebodies, come home, stay homeLots of children in the neighborhoodLive on a busy, fast paced street
Are there children living in the home*

yesno
Ages of children*
How many people are living in your home including yourself*
Are all people living in your home aware you are adopting a dog*

yesno
If yes, does everyone approve*

yesno
Does anyone living in your home have allergies to dogs*

yesnoI don't know
Where will the dog be kept most of the time*

Inside the homeIn a cratein the garageoutsidepatio/porchOther
If "other", please give more info
where will your dog sleep*

cratepet bedwith ownerdesignated roomoutsidegaragepatio/porch
where will your dog be when no one is home*

free inside homecrategarageoutside in fenced yard
what will he/she do for potty breaks and exercise*
who will be responsible for training, exercise, and caring for the dog*
how many hours will the dog be alone in a typical 24 hour day*
What arrangements will you make for your dog when you are traveling*
Do you currently have other pets*

yesno
If so, names, ages, breeds*
For current pets, check all that apply

Up to date on vaccinesspayed/neuteredLicensed in my countyflea treatment
If not spayed or neutered, please provide the reason why
Have you had any other pets in the last five years*

yesno
If yes, what happened to them*
Do you have any experience with the following*

Obedience trainingPotty trainingcrate trainingModifying behavioral issues
We don't always know what kind of training a rescue dog has. Are you committed to potty training and any other training your adopted dog may need?*
Are you willing to enlist a trainer or commit to training classes with your dog if needed*

yesno
Please include any other training or other experiences that you think would be beneficial when adopting one of our dogs
Please check types of confinement you can provide*

cratekennel rungated roomfenced yard
Most dogs need time to adjust to new people and surroundings. How much time are you willing to allow for adjusting and bonding*

Two weeksA month or longerAs long as it takes
Under what circumstances would you feel it necessary to give up this dog*

Barking/whiningmovingdog damages propertyfamily dynamic change: marriage, divorce, new babydog becomes illpotty accidentsNone- pets are familyOther
Have you ever surrendered a dog to a shelter or Humane Society or rehomed to another person and if yes please explain*
If your pet went missing, what would you do?
Have you ever been denied adoption by a rescue, please explain
Any animal violations, if yes please explain*
Have you or anyone in your household ever been convicted of animal neglect or abuse or other crimes. If yes please explain*
Please provide veterinarian name, phone number, and location*
A home visit by one of our rescue representatives is a requirement. Do you you consent to a home visit*
Please provide three references including, name, phone number,and relationship*
IMPORTANT: All of the information I have provided is true and complete to the best of my knowledge. I agree to follow all rules and policies of Imagine Peace for Pups Rescue, Inc. I understand it is my decision on whether to adopt a dog or not. I will not hold Imagine Peace for Pups Rescue, Inc. responsible for any damage, injury or harm caused directly or indirectly to any person or property by any dog that I agree to adopt. Imagine Peace for Pups Rescue, Inc., at its sole discretion, reserves the right to refuse any applicant for any or no reason.

I agree that I will not make any claims against, sue or attach any property of Imagine Peace for Pups Rescue, Inc., its directors, officers, agents, employees, and/or volunteers for any injury or damage caused by any animal(s) adopted from Imagine Peace for Pups Rescue, Inc.

By submitting this application, I agree to all stated policies, releases, and wavers.
Do you agree to all terms stated above*

yesnoI have questions that I will discuss with a rescue representative
Questions:
Signature*
Should be Empty:

DOG Adoption Application Imagine Peace for Pups Rescue, Inc.