Scooter's Pals Adoption Application

This questionnaire is designed to help Scooter's Pals and you determine if a specific dog is the right one for you and your household. This form may seem long, but it is quick and easy to complete. And because the form is encrypted when you submit it, y0ur information is safe and secure.

All who want to adopt a Scooter's Pals dog are required to complete this form and, if approved, an Adoption Contrat prior to adoption. Scooter's Pals reserves the right to deny any adoption based on answers to this questionnaire, a home check and/or interviews prior to adoption.

Although time and staff limitations mean we cannot respond to every application received, you will hear back from us within two weeks if it's appropriate to continue with you to the final steps.

Standard Adoption Fee $250

Our adoption fee is our attempt to recoup part of what it costs our rescue for the care each of our dogs receives. Depending on how much care a dog requires, the adoption fee may vary.

Scooter's Pals is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected, abused and homeless animals. Scooter's Pals is completely funded through fundraising efforts and public donations. All of our pets are cared for in foster homes and receive complete medical care, which includes a thorough vet exam, vaccinations, spaying/neutering, heart worm test and microchipping prior to their adoption.

Disclaimer: Due to the limited time spent with the rescued animals, Scooter's Pals is not responsible for the health, behavior, or temperament of the animals listed by or adopted from our organization.

Application date

Date

Name of dog you're interested in *

Dog's breed *

Your full name *

First Name Last Name

Your age *

Under 21 21-25 26-40 41-55 56-65 66-75 Over 75

Street address *

Address 2

City *

State *

Zip code *

Home Phone *

Area Code Phone Number

Work Phone

Area Code Phone Number

Cell Phone

Area Code Phone Number

Email *

Employer, City

What is/was your line of work? *

Personal reference 1 *

Reference 1 phone *

Area Code Phone Number

Personal reference 2 *

Reference 2 phone *

Area Code Phone Number

Are all members of your household in agreement with this adoption? *

Yes No I don't Know

Who will be the pet's primary caregiver? *

Do you live in a *

House Apartment Condo Mobile Home

Do you own or rent? *

Own Rent

How long have you lived there? *

If renting, provide name of landlord or manager

Landlord/manager's phone

Area Code Phone Number

Does your landlord allow dogs?

Yes No

Are there any restrictions from your landlord or subdivision? *

Number of pets Breed restrictions Size or weight restrictions None

Do you have a yard? *

Yes No

If yes, what size is it?

Is it fully fenced? *

Yes No N/A

If yes, height and type of fence

Do you have any of the following?

Underground fence Kennel Dog Run

Do you have a pool? *

Yes No

How many adults are in your household? *

Gender and ages of all adults in your household? *

If children, what are their gender and ages? *

Have your children been around animals before?

Yes No

Does anyone in your home have allergies to dogs or have asthma? *

Yes No

List type/breed, gender and ages of any animals that live in your home *

How many of these pets are spayed/neutered? *

Are they up to date on vaccines, flea and heart worm preventative? *

Yes No I'm not sure

Have you owned dogs in the past?? *

Yes No

If so, what happened to them? *

Have you adopted from an animal welfare group before?

Yes No

If yes, what group?

Have you ever given up a pet? *

Yes No

If yes, what were the circumstances?

Name and phone number of your current and/or previous vet or clinic *

What type of personality do you want your dogto have?

Energy

High energy Medium energy Calm Couch-potato No preference

Age

Baby Young adult Adult Mature adult Senior No preference

Gender

Female Male No preference

Size

Tiny Small Medium Large Extra large No preference

Coat

Short Medium Long No preference

What other characteristics or traits are you looking for?

If necessary with your new dog, can you provide

House training

Yes No

Crate training

Yes No

Obedience training

Yes No

Additional assistance you can provide to your dog

Where will the dog spend the day? *

How many hours a day will the dog spend alone? *

In case of an emergency, who can take care of your dog if you're unable to be at home? *

Where will your new dog stay when nobody is home? *

How many hours a day will the dog spend outside? *

How will you supervise the dog's outdoor activity? *

What will be the dog's sleeping arrangements? *

What activities do you plan for your dog? *

What length of time will you allow your new pet to adjust to his/her new home? *

Are you willing to work through your new pet's issues, if any? *

Yes No

Adopting a dog is a commitment that could last 10-18 years and cost at least $300-$500 per year. Are you ready and willing to make this commitment? *

Yes No I'm not sure

What circumstances would lead you to give up your new dog? *

If you had to give up your dog, what would you do with him/her? *

How did you find out about Scooter's Pals? *

Friend/Family Petfinder.com Facebook Other website Petco Newspaper/Radio/TV Other

Scooter's Pals sends occasional newsletters and updates via email to adoption applicants. You may opt out and unsubscribe at any time if you prefer not to receive those messages.

Adoption Application

Applicant Information

Your Household

Current/Previous Pets

New Pet Information