Adoption Application
Name of the dog you are interested in adopting (if applicable):
If you have already chosen a dog from our rescue, please tell us why you think this dog is right for you.
If you haven’t chosen a dog from our rescue, please tell us what type/size/sex you are looking for and why.
Adopter's Name:
*
First Name
Last Name
Spouse/Partner's Name:
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
*
-
Area Code
Phone Number
E-mail
*
How long have you lived at your present address?
*
Do you rent or own your home?
Rent
Own
Other
If renting, do you have permission to keep a dog indoors?
Yes
No
Landlord name:
First Name
Last Name
Landlord Phone Number
-
Area Code
Phone Number
Do you live in a house/apartment/other?
*
Do you have an HOA?
*
Yes
No
I don't know
If so, are there restrictions pertaining to owning animals?
HOA Name
HOA Phone Number
-
Area Code
Phone Number
Do you have a fenced yard?
*
Yes
No
Other
Type and height of fence:
If unfenced how to you plan to control your dog while outside?
Do you have a separate kennel run?
Yes
No
Kennel height and type:
What type of floor does your kennel have?
How many adults are in your household?
*
How many children are in your household?
*
Please list ages and gender of children:
Are there regular visitors to your home, human or animal, with whom your new dog must get along? (Please list.)
Do you have other dogs?
*
Yes
No
Give Breed, Sex, Age and temperament of each dog:
Are they all spayed/neutered?
*
Yes
No
Some
If no, why not?
Do you have a regular veterinarian?
Yes (if so, please list in the reference section below)
No
Veterinary Clinic you use
Please contact your Veterinarian's office and let them know a representative of Valhalla rescue will be contacting them and allow them to release information to us.
Veterinary Clinic Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Veterinary Clinic Phone Number
-
Area Code
Phone Number
Veterinary Clinic Hours
How many dogs have you owned in the last 5 years?
*
If no longer with you, please explain why and be specific.
Do you own cats?
Yes
No, and there are none around our home
No, but we have them around our home
How well do they get along with dogs?
Where will the dog spend the day?
*
Where will the dog spend the night?
*
If you are to go on vacation where would the dog stay or would it go with you?
*
How many hours per day, on average, will the dog spend alone?
*
Have you ever surrendered an animal to rescue or a shelter of some type before? If so, why?
*
If asked, will you provide Valhalla Rescue with info needed to perform a background check to verify?
*
Yes
No
Are you willing to let a representative of Valhalla Rescue visit your home by appointment?
*
Yes
No
If no, why?
References
Please provide 3 personal references below. If you have a regular vet, please list them as one reference. Keep in mind, these people should know you personally, have met your current pets and have been to your home within the past year.
Reference #1: Name
*
First Name
Last Name
Reference #1: Relationship to you
*
Reference #1: Phone Number
*
-
Area Code
Phone Number
Reference #2: Name
*
First Name
Last Name
Reference #2: Relationship to you
*
Reference #2: Phone Number
*
-
Area Code
Phone Number
Reference #3: Name
*
First Name
Last Name
Reference #3: Relationship to you
*
Reference #3: Phone Number
*
-
Area Code
Phone Number
All the information I have given above is true and complete. Valhalla Rescue has my/our permission to contact individuals and/or businesses I have listed in the above responses. Should an unsprayed or neutered dog be placed with me, I agree to have it spayed or neutered within one (1) month of adoption or by a date agreed upon by me and Valhalla Rescue. This dog will reside in my home as a pet. It is solely my responsibility to provide adequate food, water, shelter, training, affection, safety and medical care. I understand that Valhalla Rescue is a rescue/referral service and is not responsible for the accuracy of information received about temperament, habits, or physical condition of the dogs available for adoption. I understand that is my responsibility to see and evaluate the dog for myself before agreeing to adopt it. I am in full agreement with these terms of adoption. Valhalla Rescue is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household and I/we agree to indemnify and hold harmless Valhalla Rescue and its’ officers, members, and/or agents from any claims for damages arising from actions of a dog adopted by me/us. I/we also understand that my/our dog will be micro chipped prior to adoption and that Valhalla Rescue shall remain as “alternate contact” through the micro chipping service and if for ANY REASON, we are no longer able to provide a home to the dog adopted through Valhalla Rescue, we shall immediately notify them of the situation and with their approval either place the dog in an home approved by Valhalla Rescue or return the dog to the possession Valhalla Rescue.
Date
*
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Month
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Day
Year
Date Picker Icon
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Hour
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10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Applicant's Signature
*
Spouse/Partner Signature
Additional questions, comments or concerns?
Optional - Attach any photos you feel may be important to us in our decision making process. :)
Submit
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