Revised Adoption Application

Date submitting form:*

MonthDayYear
Date
Name of dog(s) you are interested in adopting:*
Applicant Information
Full Name:*

First NameLast Name
Age:
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact number:*
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Cell Phone:*
Format: (000) 000-0000.
Occupation:*
E-mail:*
Co-Applicant Information
Full Name:

First NameLast Name
Age:
Occupation:
E-mail:
Work Phone:
Format: (000) 000-0000.
Cell Phone:
Format: (000) 000-0000.
Residence Information
Where do you live?*

HomeCondoTownhouseApartmentModular Home
Do you:*

RentOwn
Do you have a fenced in yard?*

NoYes
If yes, what type (ex. 6ft wood, 4ft chain link, etc)?
If you rent, do you have the landlord's permission to own a dog?

NoYes
Landlord's name (if you rent, this is required):

First NameLast Name
Landlord's phone (if you rent, this is required):
Format: (000) 000-0000.
Are there children at this residence?*

NoYes
If yes, list each child's age:
Please list all other residents of the home and their ages:
Current Animals/Future Adopted Dog(s)

Please answer the following questions in regards to any dogs or cats that you own. If you do not have any dogs or cats, please answer the following questions as if the dog you are interested in was already yours:
Do any of the dogs live primarily outdoors?

NoYes
Are they allowed on the furniture?

NoYes
Do you keep an ID tag (other than rabies) on the dog(s)?

NoYes
What type of food to you feed your pets?
Where do they sleep at night?
Are your existing pets up-to-date on all vaccinations and preventatives as recommended by your veterinarian?*

NoYesN/A
Do you authorize us to contact your veterinarian to verify this information?*

NoYesN/A
Initial here:
Current veterinarian:
Veterinarian's phone number:
Format: (000) 000-0000.
Veterinarian's email:
example@example.com
Please list the type(s) of animal(s) currently living in your household and any animal(s) you have had in the past 5 years. If none, please continue to the "New Dog" section.
Name:
Type of animal:
Do you still have the animal?

NoYes
Gender:

Female, intactFemale, spayedMale, intactMale, neutered
Personality of pet:.
Age of pet:
Weight of pet:
Where does pet stay during day?
Do you have a second pet?

yesno
Name:
Type of animal:
Do you still have the animal?

NoYes
Gender:

Female, intactFemale, spayedMale, intactMale, neutered
Personality of pet:.
Age of pet:
Weight of pet:
Where does pet stay during day?
Do you have a third pet?

yesno
Name:
Type of animal:
Do you still have the animal?

NoYes
Gender:

Female, intactFemale, spayedMale, intactMale, neutered
Personality of pet:.
Age of pet:
Weight of pet:
Where does pet stay during day?
Do you have a fourth pet?

yesno
Name:
Type of animal:
Do you still have the animal?

NoYes
Gender:

Female, intactFemale, spayedMale, intactMale, neutered
Personality of pet:.
Age of pet:
Weight of pet:
Where does pet stay during day?
Do you have a fifth pet?

yesno
Name:
Type of animal:
Do you still have the animal?

NoYes
Gender:

Female, intactFemale, spayedMale, intactMale, neutered
Personality of pet:.
Age of pet:
Weight of pet:
Where does pet stay during day?
New Dog
Do you have a gender preference?*

FemaleMaleNone
Do you have an adult weight preference?*
Be as specific as possible
Do you have an age preference?*
Be as specific as possible
If you adopt a puppy that has not been spayed or neutered, do you agree to have the procedure done?*

NoYes
Does everyone in the household agree to the adoption of a dog?*

NoYes
Who will be responsible for the daily care of the dog?*
Please check any of the following reasons for adopting a dog:*

CompanionGuard dogHuntingChild's petGiftFamily memberOther
If other, please explain:
Who will be responsible for the obedience training of the dog?*
If training with someone other than a professional, has the person successfully trained a dog before?*

NoYes
What skills and/or tricks have you taught your previous dogs?
Approximate amount of time per day spent in play/exercise and type of activity.
If you adopt a dog that has not been housebroken/crate trained, are you able to make the necessary time commitment to train the dog?

NoYes
How many hours will the dog be home alone on a typical day?*
How many hours a day will the dog spend inside the house?*
Where will the dog stay when home alone during the day?*
Where will the dog sleep at night?*
If you are considering a long-haired breed, how often would the dog be groomed?
How much do you estimate a dog to cost annually?
The dog will eventually become elderly with the possibility of failing health (arthritis, blindness, heart disease, kidney disease, cancer, etc.).
Are you able to afford the cost of veterinary care for an elderly dog?*

NoYes
A dog can live for 10-15 years. Can you commit to caring for a dog for that length of time?*

NoYes
What circumstances, in your mind, justify giving a dog up? (select all that may apply):*

movingmedical problems with dogmedical problems with ownernot getting along with other petsallergiesbehavioral problemshousebreaking problemssheddingchildren lost interesttoo time consumingnew babyif it gets too bigaggressive behaviorothernone
If other or none, please explain:
Have you ever given up a dog?*

NoYes
If yes, please explain:
If circumstances forced you to give up a dog, how would you go about doing it?*
Have you ever looked at or applied to adopt with Athens Canine Rescue?*

NoYes
If yes, did you adopt?

NoYes
If yes, who?
If no, why did you not adopt?
How did you hear about Athens Canine Rescue?*

Adoptapet.comAdoption/Community EventAthensCanineRescue.comFacebookFlagpolePetFinder.comPrevious AdopterWord of mouthOther
If other, please explain:
Please tell us more about yourself, your family and the type of dog that you are looking for.*
Personal References
List 3 different personal references. Tell your references they should expect an email for our Adoption Coordinator.

Do not list your own email address for your references. Please take the time to ask them for their email address.

We cannot process your application without responses from your references.
Reference 1's name:*

First NameLast Name
Relationship with reference 1:*
friend, parent, vet, etc.
Reference 1's Email:*
example@example.com
Reference 1's phone number:*
Format: (000) 000-0000.
Reference 2's Name:*

First NameLast Name
Relationship with reference 2:*
friend, parent, vet, etc.
Reference 2's Email:*
example@example.com
Reference 2's Phone Number:*
Format: (000) 000-0000.
Reference 3's Name:*

First NameLast Name
Relationship with reference 3:*
friend, parent, vet, etc.
Reference 3's Email:*
example@example.com
Reference 3's Phone Number:*
Format: (000) 000-0000.
By typing my full name and initialing the boxes below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of a rescue dog and removal of said dog from my home.

*Applicant must be at least 18 years of age. Athens Canine Rescue reserves the right to refuse any applicant.
Applicant's Full Name:*

First NameLast Name
Initials:*
Co-Applicant's Full Name:

First NameLast Name
Co-Applicant's initials:
Check the box*
Once this form is successfully submitted, you will receive an email from JotForm; if you do not receive this email, we did not receive your application.

If you have not received a reply from ACR within 48 hours, please email adopt@athenscaninerescue.com or rescue@athenscaninerescue.com for any questions or comments.

Thank you for your interest in adopting a dog through Athens Canine Rescue!
Should be Empty:

Applicant Information

Co-Applicant Information

Residence Information

Current Animals/Future Adopted Dog(s)

New Dog

Personal References