Rescue Dog Adoption Application

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Relinquished Soul's is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals and is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.

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This questionnaire is designed to help Relinquished Soul's and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. Relinquished Soul's reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!

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Name of the dog you are interested in:* This field is required.

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Your full name:* This field is required.

5

Your age:* This field is required.

6

Street Address:* This field is required.

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City, State, Province, Postal code or Zip* This field is required.

8

Home Phone:

Area Code

Phone Number

9

Work Phone:

Area Code

Phone Number

10

Cell Phone:

Area Code

Phone Number

11

E-mail:

12

Employer:

13

Character reference and phone number:

14

Are all members of your household in agreement with this adoption?* This field is required.

Yes

No

Don't Know

15

Who will be the pet's primary caregiver?* This field is required.

17

Do you own or rent?* This field is required.

Own

Rent

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If rent, provide name and phone number of landlord:

19

Does your landlord allow dogs?

Yes

No

20

Are there any restrictions from your landlord or subdivision?* This field is required.

Number of pets

Size or weight restrictions

Breed restrictions

None

21

Do you have a fully fenced yard?* This field is required.

Yes

No

22

Height and type of fence

23

Do you have any of the following?

Underground fence

Kennel

Dog Run

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How many adults are in your household?* This field is required.

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How many children are in your household?* This field is required.

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If children, what are their ages?

27

Have your children been around animals before?

Yes

No

28

Does anyone in your home have allergies to dogs or have asthma or other medical /mental conditions such as PTSD,anxiety disorders or severe depression which may affect caring for the dog?* This field is required.

Yes

No

29

List any pets you own or have owned in the past 10 years. Include name, breed, age, gender, spayed/neutered, UTD on vaccines, living/deceased

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How many of these pets are spayed/neutered?Are they all UTD on yearly vaccines?

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Where are these animals now?

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Do you have farm animals?

YESNO

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Have you adopted from an animal welfare group before?

Yes

No

34

If yes, what group?

35

Have you ever given up a pet?

Yes

No

36

If yes, what were the circumstances?

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Please provide the name and phone number of your current and/or previous veterinarian or clinic:

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What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)* This field is required.

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Are you aware of crate training?* This field is required.

Yes

No

40

Have you ever house-broken a dog or puppy before?* This field is required.

Yes

No

41

When housetraining your dog what types of corrections do you plan to use?* This field is required.

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How many hours each day will your new pet be home alone?* This field is required.

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Where will your new pet sleep at night?* This field is required.

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How will you supervise the dog's outdoor activity?* This field is required.

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Where will your new dog stay when nobody is home?* This field is required.

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What length of time will you allow your new pet to adjust to his new home?* This field is required.

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Are you willing to work through your new pet's issues, if any?* This field is required.

Yes

No

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Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?* This field is required.

Yes

No

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Do you understand that a dog can be an 18 year commitment, and can cost $1000 - $5000 per year to care for?* This field is required.

Yes

No

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Do you plan to take an obedience class with your dog?* This field is required.

Yes

No

Not sure

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If yes, where?

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Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for?* This field is required.

Yes

No

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What circumstances would lead you to give up your new dog?* This field is required.

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If you had to give up your dog, what would you do with him/her?* This field is required.

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I understand that I assume full responsibility for the welfare of this pet from the date of adoption.

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Once submitted you should receive CONFIRMATION your application has been sent. We have been experiencing tech glitches so FB MESSENGER us to verify it’s been received.