Adopt Me!

Applicant Name

First NameLast Name

Co-Applicant Name

First NameLast Name

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

YesNo

Employment:

Name of Dog you are interested in adopting:

Why do you want to adopt?

How long have you been looking for a pet?

What is it about the dog that appeals to you?

What qualities are you looking for your in an adoptive pet? In other words, describe your ideal dog.

Are you willing to adopt a dog that may prefer to be the only pet in the home? If you do not have any current animals do you plan on having more than one?

Who will be primary caregiver for this dog?

Does anyone in the home have allergies (animals)?

What would you do in the event it was found someone in the home was allergic to your newly adopted dog?

Have you adopted from any other rescue or shelter in the past? If yes, which agency?

Have you ever surrendered a dog to a shelter or rescue?

YesI need more informationNo

List of people in your household (including children and ages):

Is everyone in the family in agreement with the pet you want to adopt?

YesNoI need more information.N/A

YesNoI need more information

How much are you expecting to spend on your dog per year? (Including but not limited to: routine veterinary care, food, bedding, toys, etc.)

If your pet becomes ill, how much would you be willing to spend? (i.e. 'EMERGENCY FUND')

YesNo

If the pet you are adopting is not house trained, what method will you use to help them succeed?

YesNoOther

Do you have any dogs and/or cats at home now? (Please list ALL of the following: age, breed, sex and temperament).

YesNoN/A

As an adult have you ever been a pet owner?

Have you had any other pets in the past five years? If so, what happened to them?

Name of Current Veterinarian and Phone Number:

Rent/LeaseOwn

Name of Landlord and Phone Number/Email (if rent/leasing) *Please note we will contact landlord:

How long have you been at this address?

If you had to move, what would you do with your adopted dog?

Do you intend to keep this animal inside, outside, or both? (Please note this refers to where the dog will live - we understand they will go outside for potty breaks!)

YesNo

If yes, please explain what type and is the whole yard fenced in?

If there is no fence, please explain how you plan to contain, allow for bathroom breaks, exercise, etc.

Where will your dog sleep at night?

Where will your dog stay while you are gone at work, weekend trips, holiday/vacations?

How many hours per day on average will your dog be left alone?

YesNo

Rescue dogs often have an unknown past. RR can not guarantee any temperaments of our rescues. How long do you intend to allow for this dog to adjust to your home/lifestyle? Note: We operate by the rules of 3's: In the first three days, your new pet may be overwhelmed with his new surroundings. He may not eat, or be himself. After three weeks, he’s starting to settle in, feeling more comfortable, and realizing this just might be his home. He lets his guard down and may start showing his real personality for good or not so good. After three months your pet is now comfortable in his home. You have built trust and a true bond.

Additional Comments:

If you are unable to keep this dog for any reason during its lifetime, we require that you contact Raising Rogue. Once a RR dog, always a RR dog.

Personal Reference 1

Phone Number

Area CodePhone Number

Email

example@example.com

Personal Reference 2

Phone Number

Area CodePhone Number

Email

example@example.com

Yes

Full Name of Applicant

First NameLast Name

Signature

Date

MonthDayYear

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