TLC Rescue: Dog Adoption Application

Name of the animal you want to adopt*
Adopter's Name*
First & Last Name
Date of birth *
Co-Adopter's Name*
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's E-mail*
example@example.com
Phone Number*

Area CodePhone Number
Names and ages of all residents in your home (adults/children)*
Do you currently have any pets?*

YesNo
If you currently have pets, please list them below.
Are your current pets altered?

YesNoWill be within the next 30 days, appointment has been scheduled. (We will call your vet to verify this.)
Vet reference (please call your vet and give permission to release information to us)*
Vet name, address & phone number
Two Personal References. Name and number*
When will you be ready to adopt this animal?*

TodayThis weekendWithin a weekWithin a monthNot ready yet, just researching
Are you in contact with any other rescues or shelters about a specific animal?*

Yes, application is pendingYes, just an email inquiry, no app yetNo, but I am looking at several animals onlineNo, I am only interested in this particular animal
Are you going to meet another animal?*

YesNo
If so, when?
I/We live in a*

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

RentOwn
Renters, have you contacted your landlord to find out if there's any restrictions on the kind or size of animal you can have?

YesNoNot yet, but I willIt's written in our lease
Approximate square footage of your home

Less than 800 square feet800-1,000 square feet1,000-1,500 square feet1,500-2,000 square feetOver 2,000 square feet
Do you have a yard?*

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

YesNoOne applicant is home/works from homeWe work different shifts
Name of employer*
If you both work outside the home, how many hours per day are you away?*
How many hours per day will this animal be alone? Please explain.*
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
Upon meeting the animal, what would give you cause to not want to adopt it? Please explain.*
Fantasy question: What would your dream pet be like? (If this animal is not a fit, we may be able to recommend another based on what you say here.)*
What activity/energy level do you prefer?*

Wild and crazy is coolDaily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, a total couch potatoOther
Please check all that apply. I want to adopt this animal...*

As a family petTo train/use for huntingTo train/use for agilityTo train/use as a therapy animalTo train/use as an assistance animal for the disabledTo use as a guard dogFor a jogging/hiking partnerTo interact with lots of friends/familyAs a gift for a friend, partner, or family memberAs 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 pet 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 usWill 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 going camping with usBe going on boat trips with usBe outside with a dog house in a fenced areaBe outside chained/tethered to a dog houseBe free roaming on the farm (unfenced)Other
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 animal?*

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 an animal?*
What do you feel is a reasonable amount of time for an animal to adjust to life with you/your family?*
Do you have any additional comments, questions or concerns? Anything else you would like us to know?*
I understand that completing this application does not guarantee I will be able to adopt this specific anima, and that the application is a tool to help Blair's Buddies Pet Rescue determine if this animal and my family are a good fit for each other. I acknowledge that all information provided on this form is true and correct. I understand that any misrepresentations may result in my not being approved and/or removal of the adopted animal from my possession. I also certify that I have never been convicted of animal cruelty or neglect.

I agree to allow a representative from Blair's Buddies Pet Rescue to contact my vet for a reference. If I am approved to adopt an animal, I agree to pay a non-refundable adoption fee and hand sign an adoption contract at the time of adoption.

I understand that the breeds of the animals in Blair's Buddies Pet Rescue are unknown and are a best guess by the rescues veterinarian and volunteers.
Please read the above, check this box, sign, and click Submit.*

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