Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Area CodePhone Number

Who are you interested in adopting?*

RESIDENTIAL INFORMATION:

Do you rent or own?*

If rent, how long is your lease?*

Put 0 if you own

If renting, what is the pet policy (size, weight, quantity, breed, etc.)*

N/A if own

Name/number of landlord?*

N/A if own

Do you have a fenced backyard?*

Is your fence block, wood or wire?*

How tall is the fence?*

Do you have a doggie door?*

How many people live in your home, including yourself?*

How many of those are children and what are their ages?*

Do you have a fenced/gated pool?*

OTHER PET INFORMATION:

Do you have other pets living in the home now?*

How Many?*

If No, put 0.

Are your pets indoor, outdoor or both?*

List the breed, sex and age of your current pets? If none currently put N/A.*

Are all your pets spayed/neutered? If not, please answer the next question.*

If you selected No, why?*

Put N/A if you don't have pets or yours are spayed/neutered.

Who is your veterinarian -- Name and Number?

NameNumber

Are you a breeder? If yes, how long have you been a breeder?*

If no pets currently, have you ever owned a dog before?

Please select your experience level of owning a dog.*

Is anyone living in your home allergic to dogs?*

ADOPTING DOG INFORMATION:

Why do you want to adopt now?*

Are you interested in adopting a dog with special needs?*

Are you familiar with large breed dogs?*

Yes or NoIf so, which breeds?

Are you willing to get behavioral training for your dog?*

Will you provide all the necessary medical, living, and maintenance care for your dog?*

Where will your dog stay during the day?*

Where will your dog sleep at night?*

How long will your dog be alone each day?*

Number of hours approximately during the day

Will you treat this dog as a loving member of your family?*

ADDITIONAL INFORMATION:

Have you ever had to surrender or return a dog that you owned? *

If yes, please explain.

Have you ever lost a pet? *

If yes, please explain.

List 2 Personal References:

1st Reference*

NameNumber

2nd Reference*

NameNumber

Are you aware that many rescue dogs have been in some way abandoned, neglected or abused? Are you prepared to deal with any issues that may come up because of this?*

THE COMPLETION OF THIS APPLICATION DOES NOT GUARANTEE ADOPTION A representative shall use their best judgement in reviewing this appilcation to match the best fit for you and the dog. Please be aware that there may be othe applications pending for the dog you are interested in. Pet guardianship is a lifelong commitment and we want to make sure that every dog goes to the most suitable home to fit their needs and yours.

Signature*

Adoption Form

RESIDENTIAL INFORMATION:

OTHER PET INFORMATION: