Rescue Row Adoption Application

Rescue Row Adoption Application
Rescue Row Inc. is a 501(c)3, all-volunteer, non-profit, animal welfare organization. Our volunteers are dedicated to the rescue, rehabilitation, and placement of dogs in need. Rescue Row is completely funded through fundraising efforts and public donations. All of our pets are cared for in foster homes and receive complete medical care (including vaccinations, worming, spay/neuter, microchip, and necessary medical treatment) prior to adoption.
This questionnaire is designed to help Rescue Row 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.
Applicant Information
Name/description of the dog(s) you are interested in:*
Applicant 1:*

First NameLast Name
Age:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*

Area CodePhone Number
Email:*
Employer:*
Position:*
Does another adult live in your household who should be included on this application? (Ex. spouse, partner, relative, co-applicant, etc.)*

YesNo
Applicant 2:*

First NameLast Name
Age:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*

Area CodePhone Number
Email:*
Employer:*
Position:*
When can you start a trial adoption with the dog(s) you are interested in?*
What is the primary reason you want to adopt a dog?*
Under what circumstances would you not keep this dog?*
What is the ideal personality of the dog you'd like to adopt? Check all that apply.

Running PartnerLazySocial ButterflyIndependentCuddlyActiveMellowProtector
Where would the dog be kept at night?*
Where would the dog be kept during the day?*
Do you have a dog door?*

YesNo
How many TOTAL hours would the dog be left alone on a normal day?*
Please explain.*
How many CONSECUTIVE hours would the dog be left alone on a normal day?*
Please explain.*
How many weeks out of the year are you out of town?*
When you are out of town, who would take care of the dog?*

Number of adults living in the home:*
Adult 1 Other Than Applicant(s):*

First NameLast Name
Adult 2 Other Than Applicant(s):*

First NameLast Name
Adult 3 Other Than Applicant(s):*

First NameLast Name
Adult 4 Other Than Applicant(s):*

First NameLast Name
Are there children living in the home?*

YesNo
How many?*
What are their ages?*
Do other children regularly visit the home?*

YesNo
Is anyone in your household allergic to dogs?*

YesNo
Have you had experience taking care of a dog before?*

YesNo

How would you rate your level of experience with dogs?*

	1	2	3	4	5

1 is Inexperienced, 5 is Expert

What methods would be used to train/discipline the dog?*
Have you ever housetrained a dog?*

YesNo

Veterinary/Clinic Name:*
Veterinary/Clinic Phone Number:*

Area CodePhone Number
Veterinary/Clinic Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What person's name would the vet records be under?*
As a part of the application process, a Rescue Row representative will contact your vet to verify that your pet(s) have received appropriate vet care. Have you already called ahead to give permission for your vet to release information to Rescue Row? Please note that we will contact your vet regardless of your answer. A "no" may delay the processing of your application.*

YesNo
Where do you purchase heartworm preventative?*
Is any of your pet's vet care provided through TCAP or another low-cost clinic?*

YesNo
If any of your pet's vet care is provided through TCAP or another low-cost vet clinic, please email records of your pet's medical history to info@rescuerowinc.org.*

I understand that my application will not be processed until my pet's TCAP or low-cost clinic records have been emailed to info@rescuerowinc.org.
*By providing this information, you are giving permission to Rescue Row to inquire about your pet's medical history, including but not limited to: vaccination records, office visits, and test results.

*Adoptions are based on best match for both the dog(s) and prospective adopter(s). Submitting this application does not guarantee approval. Applications may be denied for any reason.
Where did you find out about the dog you are applying for?*
Is there anything else you would like us to know?
Signature
Applicant 1 Name:*

First NameLast Name
Applicant 1 Signature:*
Date:*

MonthDayYear
Date
Applicant 2 Name:*

First NameLast Name
Applicant 2 Signature:*
Date:*

MonthDayYear
Date
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Should be Empty:

Rescue Row Adoption Application

Applicant Information

Signature