Stepping Stones Adoption Application

Date*

Date

Name of the Dog(s) You Wish to Adopt

How did you hear about this dog?

CONTACT INFORMATION

Your name*

Name of Co-applicant, if applicable

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Alternate Phone

Area CodePhone Number

E mail*

example@example.com

Alternate E mail

example@example.com

HOME INFORMATION

Do you:*

OwnRentOtherOther

If you rent, please provide name and contact number of landlord

Home setting:*

CitySuburbRural

How long have you lived at your current address?*

Are you over 21?*

YesNo

Are you employed?*

YesNoRetired

Do you plan to move within the next year?*

YesNo

How many adults reside in your home?*

Please list the ages of each child in your home.

On a typical day, how long with the dog/puppy be left alone?*

Where will he/she be kept when you are not at home?*

Is your yard entirely and securely fenced?*

YesNo

If fenced, please describe your fencing:

If your yard is not fenced, describe how will you safely secure the dog when outside:

Would you still be able to care for this dog if your home or family situation changes (i.e. divorce, marriage, relocation, etc.)?*

YesNo

OTHER PETS

Do you currently own other pets?*

YesNo

Please list any pets you share currently or have shared within the past ONE year:

If you have recently (in the past year) lost a pet, please share the cause of death:

Please list previously adopted pets and their details. You may estimate adoption date, if unknown.

VET INFORMATION

Do you have a vet?

YesNo

If not, why not?

Do we have permission to call your vet for a reference check? Please contact your vet and authorize them to speak to us.

YesNo

Veterinarian Name (If you have one):

Address:

Phone Number:

Area CodePhone Number

PERSONAL REFERENCES

Please use references of people that live OUTSIDE your home.

Reference 1 Name:*

Relationship:*

Address:

Home #:*

Area CodePhone Number

Cell #:

Area CodePhone Number

Email:

example@example.com

Reference 2 Name:*

Relationship:*

Address:

Home #:*

Area CodePhone Number

Cell #

Area CodePhone Number

Email:

example@example.com

EXPERIENCE AND PREFERENCES

Describe your lifestyle. Select all that apply.*

Please add any additional information about your lifestyle.

Preference for your dog's activity level. Select all that apply and description of "Other," if applicable.*

Please add details on your dog's activity level.

What are your plans to exercise your dog?*

What are your preferences for the sex of your dog?*

MaleFemaleEither

What are your preferences for the age of your dog?*

BabyYoung adult (under 1 year)Adult (over 1 year)Senior

Tell us about your family and dog experience.*

If you have ever had to surrender a pet to a rescue or shelter, please tell us about the circumstances. Please be specific.

Are you aware that most shelter and rescue animals have unknown backgrounds and that while we do our best to guess at breed, age, temperament, we cannot be 100% accurate?*

YesNo

Have you recently had a dog or puppy with Distemper, Parvo or Coronovirus?*

What drew your attention to this particular animal?

Why do you think you would be a good home for this animal?

When will you be ready to adopt?*

Are you willing to travel to our location (Charleston WV area) to pick up your dog? If not, where can you meet us to pick up dog?*

Do you agree to:*

License your dog (if applicable)Provide regular health care

Do you agree to contact us if you can no longer keep your adopted pet?*

YesNo

What do you estimate to be the annual cost of owning a pet? Not including emergencies.*

By submitting this application:

I acknowlege that I have completely read this questionaire and comprehend it fully.
I understand that in submitting this application, it does not guarantee I will be approved for this pet.
I agree to the adoption fee which includes: health exam, spay/neuter, worming, Distemper Combo vaccination, Rabies vaccine (if old enough for this vaccine prior to adoption), flea and tick treatment and microchipping.

ADOPTION APPLICATION

Instructions

Application