Adoption Application form

Dog of Interest

Full Name*

First NameLast Name

Age

E-mail*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number - Home

Area CodePhone Number

Phone Number - Cellular

Area CodePhone Number

Phone Number - Work

Area CodePhone Number

Do you live in a:

Do you:

OwnRentLive with ParentsOther

If Renting: Please indicate landlord contact information

Describe your Homes Activity Level

Busy/NoisyModerate Comings/GoingsQuiet with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)*

Does Anyone in your Household have Allergies to Animals?

YesNo

Are all members of your Family agreeable to Fostering a Dog?

YesNo

Please List any Pets you have (Please include Name, Breed, Age, Altered, Sex, UTD Vaccines, Heartworm*

Do you have a preference in sex of foster?

MaleFemaleNo Preference

What age dog would you consider?

What size dog are you willing to adopt? (Check all that apply)

SmallMediumLarge

Please describe the type of dog you are looking to adopt (Please include breed, coat length, personality traits, energy level, hypoallergenic) We always want to make sure we have the best fit for everyone.

Are you willing and able to medicate your dog, even if it just a monthly heartworm preventative?

YesNo

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?

YesNo

Have you had any experience with with an emotionally or physically neglected or abused dog?

YesNo

If Yes please explain

Are you willing to use a crate for a dog if recommended?

YesNo

Do you have a fenced yard?

YesNoPartial

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

How many hours in a day would the foster be left alone?

What are you plans to exercise you new dog? Please list any parks near by or trails, how many walks a day, approximate length, and activities such as agility.

Please list 3 personal references with names, addresses, phone numbers and how related. We prefer it not to be all relatives. Are you ok with this?

YesNo

Vet Reference: Full Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #1: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #2: Full Name*

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference #3: Full Name

First NameLast Name

Relation to applicant(s):

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully.

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any ANGELS 2 THE RESCUE animal adopted by me.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically, I agree to release and covenant to hold harmless ANGELS 2 THE RESCUE and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the foster dog.

I accept full responsibility for the dog(s) actions at all times, and release ANGELS 2 THE RESCUE from any liabilities or damages that may incurre.

I agree to have ANGELS 2 THE RESCUE complete reference call checks and conduct a home visit inspection to be able to approve my adoption application.

I agree that if, for any reason, I'm unable to keep or provide for the dog(s) anymore that I will return the dog(s) to ANGELS 2 THE RESCUE and try to give ANGELS 2 THE RESCUE a 2 week period to try and find another suitable foster for the dog(s). I also understand that the adoption "fee" is actually a tax deductible donation and it is nonrefundable.

Date

MonthDayYear

Your name*

Signature