Dog Adoption Application

DOG APPLICATION

Take Me Home Pet Rescue
You must be 18 or older to complete this application.
Name of the dog you want to adopt*
Second Preference of a dog you would adopt*
Adopter's Name*
First & Last Name
Co-Adopter's Name
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's E-mail*
Co-Adopter's E-mail
Best Phone Number*

Area CodePhone Number
Phone Type*

CellHomeWork
Second Phone Number

Area CodePhone Number
About You
Names and ages of all permanent residents of your home (adults/children)*
Will this be your first pet?*

YesNo
Do you currently have pets?*

YesNo
Please list all pets you have had in the past 5 years:*
Species, Breed, Name, Age, Sex, Altered yes or no?
Are your current pets spayed/neutered?

YesNo
Are your current pets up-to-date on their vaccinations?

YesNo
Are you familiar with heartworm disease?*

YesNo
Veterinarian's Information
Is the Veterinarian you are about to list the Veterinarian where your dog's vaccination/preventive history is?*

YesNo. If not, please list the vet who has your pet's medical history.
Name of the PET this vet is treating*
Possible alternate names the account may be under (ex. maiden name)*
Veterinarian's Name*
First & Last Name
Veterinarian's Address*

Street Address

Street Address Line 2

CityState

Zip Code
Veterinarian's Phone Number*

Area CodePhone Number
Did the vet listed above treat your previous pets?*

YesNo. If not, please provide the other vets you used for PREVIOUS pets' vaccinations and routine care.
Additional Veterinarian's Name
First & Last Name
Additional Veterinarian's Address

Street Address

Street Address Line 2

CityState

Zip Code
Additional Veterinarian's Phone Number

Area CodePhone Number
Have you ever had a serious behavior problem with a previous pet? If yes, please describe the outcome.
Has a dog ever died on your premises? If yes, please explain the circumstances.
Have you ever had to give up a pet? If yes, what were the circumstances?
Have you ever tried to adopt from another rescue group or humane society?*

YesNo
If yes, what was the outcome?
I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartment
Do you rent or own this property?*

RentOwn
If you rent, please provide the name of your land lord.*
Landlord's Phone Number*

Area CodePhone Number
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)
Do you work outside the home?*

YesNoOne applicant is home/works from home
What is your occupation?*
If you both work outside the home, how many hours per day are you away?*
Type NA if this does not apply.
How many hours per day will this dog be alone? Explain*
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
How much do you feel you can reasonably afford and would be willing to spend on your dog per year (for things like veterinary care, licensing, ID tag, food, toys, crate, other supplies, training, pet sitting, etc)? *
Please check all that apply. I want to adopt this dog...*

As a family petTo breed with my dogTo train/use for huntingTo train/use for agilityTo train/use as a therapy dogTo train/use as an assistance dog for the disabledTo use as a guard dogFor a jogging/hiking partnerTo interact with lots of friends/familyAs a gift for a friendAs a companion for my dog(s)As a companion for my cat(s)As a companion for my child/children
Please check all that apply. My adopted dog will...*

Be kept outside most of the timeBe kept indoors most of the timeBe left outside during the work day while we are awayBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usTake frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenMust be housebroken prior to adoptionWill be housetrained by usWe be walked more than one mile per day every dayWill be walked occasionallyBe attending formal group obedience classes with usBe trained by us without the advice of a trainerHave private sessions with a trainer as neededBe attending agility classesBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe given away to someone else if we feel it's not a good match for usBe turned in to a shelter if we can't keep itBe going camping with usBe going on boat trips with usOther
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?*

HousebreakingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenMouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training)GrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingCounter surfingBlindnessLimited SightDeafnessSeparation AnxietyDiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineTaking classes with the dogGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin allergiesFood allergiesTrimming nailsYeast on coat or in earsEar mitesFleasTicksHeartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.Other
What would cause you to return a dog?*
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family?*
How do you plan to integrate this dog into your family?*
What would you do if you discovered after adoption (at any time during the life of the dog) if your vet diagnosed an expensive health condition?*
Do you plan to get pet health insurance?*

YesNoI wasn't aware this was available. I will look into it.
Do you plan to take formal obedience classes?*

YesNoNot sure
Please provide 3 personal references (CANNOT be relatives)
Please remember to provide area codes
Please call all references and tell them that Take Me Home Pet Rescue will be calling them
REFERENCE # 1 - Is the reference a relative?*

If Yes - WE WILL NOT PROCESS THE APPLICATION IF THE CONTACT IS A RELATIVENo
Name of Non-Related Reference 1*
FIRST & LAST NAME
Phone Number for Non-Related Reference 1*

Area CodePhone Number
REFERENCE # 2 - Is the reference a relative?*

If Yes - WE WILL NOT PROCESS THE APPLICATION IF THE CONTACT IS A RELATIVENo
Name of Non-Related Reference 2*
FIRST & LAST NAME
Phone Number for Non-Related Reference 2*

Area CodePhone Number
REFERENCE # 3 - Is the reference a relative?*

If Yes - WE WILL NOT PROCESS THE APPLICATION IF THE CONTACT IS A RELATIVENo
Name of Non-Related Reference 3*
FIRST & LAST NAME
Phone Number for Non-Related Reference 3*

Area CodePhone Number
Take Me Home Pet Rescue reserves the right to refuse any application. We are unable to process an incomplete application. As stated in our adoption contract, Take Me Home Pet Rescue requests that if you decide at any point in time that you are no longer able to keep your pet, that you return the pet to us. If you have a relative or friend that wishes to adopt your pet, we ask that they go through our application process. This procedure is mandated by the Department of Agriculture by law.

Please understand that this comprehensive process has been developed to protect animals that are in our care and for us to abide by the regulations governing rescue groups. Many of these animals have suffered extreme hardship and have been victims of abuse, neglect or undesirable situations. It is the mission of Take Me Home Pet Rescue, to place these incredible animals in loving permanent homes with wonderful families.
Selecting 'I Agree' below constitutes an electronic signature that is valid and a legal substitution for my written signature.*

I/We have read and understand all of the above.
Applicant's Signature*
Co-Applicant's Signature
Signature Date

MonthDayYear
After you submit this form, it will take you back to the Take Me Home Pet Rescue home page. Feel free to email us with any questions: tmhpetrescue@gmail.com
Should be Empty:

DOG APPLICATION

About You

Veterinarian's Information

Please provide 3 personal references (CANNOT be relatives)

Please remember to provide area codes

Please call all references and tell them that Take Me Home Pet Rescue will be calling them