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Name:
*
Veterinarian's Address, City, State and Zip
Adoption Application
Will this pet be a surprise for anyone? If Yes, who?
Are any family members of your house hold allergic to pets?
Yes
No
Amount of pet deposit:
If Yes, what steps will you take to accommodate the dog(s) and the household member?
Please indicate where you live:
Apartment
Condo / Townhouse
House
Other
If your dog develops an expensive medical problem what would you do?
Have pet put to sleep
Give pet to rescue group or shelter
Spend whatever was needed to correct the issue
Other
Did you adopt?
Do your current or past pets receive heart worm or flea preventative? If yes, please list type and frequency. If no, why?
Name and phone of apartment complex or landlord:
If Yes, Please List Name, Relation and Age below:
What are the maximum hours pet will be left alone on a typical day?
How many children are in the home and what are their ages?
Have you ever given up a pet? If Yes, Why?
Would you try to fix the problem? If Yes, How?
Co-Applicant
If you date or marry someone who does not like or want pets, what will you do?
Have pet put to sleep
Give pet to rescue group or shelter
I would end the relationship before giving up my pet
Other
Address, City, State, Zip
*
Can you provide a permanent loving home for this dog for 10-15 years?
Please list Type, Age, Spayed/Neutered and if they are current on vaccinations:
REFERENCES: Please list two references to include: Name, Address and Phone Number.
Is there a limit to the number of pets allowed?
Yes
No
What circumstances in your mind, justify giving up a dog?
Agression
Medical problems
Ruining Furniture
Not house broken
Moving
Divorce
New Baby
Shedding
Allergies
Children lost interest
Getting loose
Barking
Not getting along with other pets
Lost job
Married
Not getting along with children
Got too big
Too time consuming
I would not give up a pet for any reason
Have you ever had a serious behavior problem with a previous dog? If Yes, Please explain.
If other, please explain
Will you ever let your dog off leash in an un-fenced area? If yes, please explain.
Is there a restriction on weight or breed?
Yes
No
Where will your new dog sleep at night?
Dog house in fenced yard
Dog house in dog pen
Dog house near tie-out
Inside in basement
In the garage
Inside free run of house
Inside in crate
In my bed
Other
How many pets do you currently have in your home?
Thank you for contacting us! If needed, you will hear back within 48-72 hours.
Are you aware of any issues that currently exist that may impact your ability to care for and / or keep a dog? If Yes, please explain:
What methods will you use for house training?
Crate training
Newspaper
Rubbing Nose
Swatting w/ newspaper
Outside only
Other
What are you working hours?
Are you willing to allow a representative to visit your home by appointment? If No, why?
How much do you expect to spend annually on vet care for your dog?
Are there any other adults living in the household?
Yes
No
Do you:
Own
Rent
In addition to those listed above, what other pets have you owned? Please describe what happened to each of those pets:
Have you ever looked at or applied for a pet with another rescue group? If Yes, Please list.
Please check any of the following reasons for adopting this dog:
Family Pet
Child's Pet
Watchdog
Companion
Hunting Dog
Guard Dog for Business
Companion for Other Pet
A Gift
Other
If other, please specify:
Is your yard fenced in? If Yes, what type and what is the height?
Employer and Occupation
Phone
*
Email:
*
Check here to receive email updates
How many times have you moved in the last 5 years?
Veterinarian's Name and Phone number
Are you willing to keep a collar and ID tag on all of your pets including a new dog at all times? If No, Why not?
Does your landlord / lease allow pets?
Yes
No
Where will your dog stay when you are not at home?
Outside in fenced area
Outside in dog pen
Outside on chain or tie-out
Inside in basement
In the garage
Inside free run of house
Inside in crate
Inside in a room in the house
Other
Work Phone and email address:
Who will be responsible for daily care and training of your new dog?
Self
Spouse
Children
Roommates
Which dog are you interested in?
*
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