Rescue Application Form

Application For Pet Adoptions
Status

New SubmissionUpdated Submission: Our info has changed since approval. We are submitting this so you can update your file.
Today's Date*

MonthDayYear
INFORMATION ABOUT YOUR RESCUE
Name of Desired Dog:*
Your Name*
Your Email Address*
Your Cell Phone Number*

Area CodePhone Number
Your Occupation
Name/ Ages of Children, if any
Current personal animals in your household (all animals not just dogs and cats) *
Your Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please indicate your age group*

18-2122-2627-3233-4546-5556-6566-7576+
Type of dwelling*

HouseCondoApartmentOther
Do you rent or own?*

RentOwn
What are your primary reasons for wanting a dog?*

Companion for youFor your kidsGiftFor other petWatchdogOther
Do you have a pet now?*

YesNoOther
Do you have other pets?*

YesNoOther
Have you ever had to surrender an animal to a shelter or rescue group?*

YesNoOther
Will the dog ever be left alone during the day?*

YesNoOther
Where will the dog sleep at night (be specific)?*
What outside areas are available to the dog? (select all that apply)*

Fenced YardEnclosed patioGarageDog HouseUnfenced common areaOther
Do you have a swimming pool?*

YesNoOther
Who has access to your yard? (Check all that apply)

No one has accessFamily membersGardenerPool manUtility workersNeighborOther
Your preferred level of exercise with your dog

Couch potatoShort walksVigorous walksHike or jog regularlyOther
Would your dog wear a collar with an ID tag?*

YesNoOther
How would you rate your level of dog owning experience?*

First time ownerBeginnerIntermediateAdvancedOther
What, if any, behavioral issues have you dealt with in the past? (Check all that apply)*

Dog aggressionPeople aggressionLeash aggressionHouse breakingSeparation anxietyEscapingFear aggressionNone of the aboveOther
Would you be willing to sign your new dog up for obedience classes at your own expense?**

YesNoOther
Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new pet?**

YesNoOther
What would happen to your pets if you moved locally, out of state, or out of the country?**
Which of the following reasons might prompt you to give up your dog? (Check all that apply)**

Excessive barkingBitingDiggingMovingDivorceBabyIllnessNot getting along with other petsPoor watchdogDestructive ChewingFinancial ProblemsOccasional Accidents IndoorsGrowling at guestsExcessive vet billsSheddingAllergiesNew spouse / partner doesn't like dogsAggression on a leashNone of the aboveOther
Please list pets you have owned since you have been an adult and the length of ownership; if they are no longer with you, please provide an explanation (died, gave away, etc.). Please list the type and breed/breed mix of each pet.
Please read and acknowledge each statement:

I understand that a home visit is required prior to final placement.I understand that a home visit does not guarantee placement.
Adopters become a part of our Rescue community. Here is what we offer our adopters and their new animal companion:

24/7 emergency answering service
Hands on Follow Up Program
Free monthly individual training consults
I CAN give an adoption fee of $300 to help cover rescue, medical care, spay/neuter, board and microchip. (Puppy adoption fee is $450)

YesNoOther
We reserves the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract.

I agreeI don't agreeOther
How did you find out about me?*

Walk inReferred by someoneFacebookOther
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Application For Pet Adoptions