Dog Application

Type a question*

I realize that the vet care for my adopted pet can cost over $1000 per year and I am willing to accept this responsibility.I live within a 90 mile radius of Larchmont, NY.I agree to pay between $350-$450 adoption free for the puppy/dog that I adopt.I am over the age of 23.I realize if my application is missing any information my application will not be processed.I am aware that this application will take about 15-20 minutes to fill out and requires information including personal references, vet references (if applicable), and work information. I will have this information available prior to moving on with the application.I am ready to adopt within 7 to 10 days. If not, please apply when ready.

Date

Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Phone Number(Alternative)

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Residence Information*

*Note: You must provide landlord or HOA contact information below to verify that pets are allowed

How long have you lived at your current residence and do you plan to move within the next year?*

Landlord Name/Condo/ Homeowners Association contact info:

List all people living in your home. List yourself first:*

	Name	Age	Relationship to Applicant	Occupation	Employers Name & Work Hours Per Day
Self
Household Member
Household Member
Household Member
Household Member
Household Member

Is anyone in the home allergic to the following?*

Dog DanderCat DanderUnknownNo Allergies

Is anyone in your home afraid of dogs (including housekeepers)? If so, please explain.

We pride ourselves with our ability to match people with pets. In order to match you with the best possible pet we need to know if there are any illnesses, disabilities or other special needs with you or any members of your household including physical (canes, walkers, wheelchairs, etc) and social/emotional (ADD/ADHD, Autism, Alzheimers, etc) needs?

If so, please explain:

Does everyone in your home agree on adopting a dog?*

YesNo

When will you be able to bring home your new dog?

Date

Additional Info:

Personal References

(not relatives)

First Reference

Full Name*

Home Phone*

Alternate Phone

Relationship*

Second Reference

Full Name*

Home Phone*

Alternate Phone

Relationship*

New Dog Information

List the names of the top 3 dogs of interest:*

Preferred Gender

Preferred Adult Size

Have you ever adopted a dog or cat from Pet Rescue before? If so, what was the dog or cat's name and when did you adopt?*

Please describe why you want to adopt a dog.*

Please describe what qualitied you are looking for in a dog.*

Are you interested in a dog you have recently seen, that is not yet listed on the website? If so, please indicate the name.

Have you owned a dog before as an adult?*

If so, did it ever have puppies?*

If you've owned a dog before and he/she is no longer with you, please explain why and be specific.

Current Pet Records

If you currently own or have owned an animal, please provide your veterinarian's name and phone number as a reference. Please provide additional vet information if you have vetted your animal elsewhere in the last 2 years.

Please write N/A if this does not apply.

Veterinarian Name, Office Name, Phone Number*

Please list all animals currenty living in your home.

Please write N/A if this does not apply.

Include: Pet Type, Name, Age, Breed, Altered (Yes/No)*

Please describe your home and yard (ie. singe family house)*

Have you taken a dog to a shelter?*

If you have, please explain.

How do you plan on exercising your new dog?*

How do you plan to have your new dog relieve itself?*

Do you have a fully enclosed fenced-in area on your property?*

If so, what is the height of, in feet?*

How many hours a day will your new dog be alone?*

Who will be the main caretaker during the day?*

Who will care for your dog during prologned absenses?*

Specifically, where will your new dog stay when it's alone?*

Specifically, where will your new dog sleep?*

What sort of training will you provide your dog?*

Employment Information

Occupation (self)*

Employer's Name (self)*

Phone Number

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Daily Work Hours*

Complete for any other adults in the home.

Employer's Name *

Phone Number

Area CodePhone Number

Employer's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Daily Work Hours*

Dog Application

Contact Information