Name
Address
City
State
Zip Code
Home Phone
Work Phone
Cell Phone
E-mail
How often do you check email?
Preferred method of contact
Please answer all questions as incomplete applications cannot be processed.
If the question doesn't apply to you, please enter "n/a" as the answer.
Use "tab" key to move between fields. "Enter" key will clear the form.
Would you like to receive email regarding events and fundraisers?
Would you consider volunteering for events or fundraisers?
Would you consider volunteering to be a foster home?
Occupation
How long employed?
Hours you are at work?
Spouse's Occupation
Name of dog or dogs currently available that you are most interested in adopting:
If this dog is not available and you would consider another dog,
what are your preferences?
Would you like to be notified as new dogs become available?
Do you prefer a male or female?
Color Preference
What role will the dog you adopt have?
Have you placed an application with any other rescue group?
If yes, please give the name of the rescue group and contact information:
How many pets have you owned in the past ten years?
What happened to them?
Please list type, age and if spayed or neutered:
If your current or previous pets were not spayed or neutered, please explain why:
Name of your current or previous vet:
Phone number of your vet:
May your vet be used as a reference?
How many people besides yourself live in your household?
Do you have children living in your home (even part-time)?
If yes, please list the number of children and their ages:
Are all others in the household aware of your intent to adopt a dog?
Do they all agree with adopting a dog?
Is anyone in your house allergic to animals?
Type of residence:
Are you planning to move in the near future?
Do you own or rent?
If renting, does the landlord allow pets?
Do you have a swimming pool?
Do you have a yard for the dog to use?
Is it fenced?
If yes, how large an area is fenced, what kind of fencing, and how high is it?
Does a door from your house open directly into the fenced yard?
How will you exercise the dog, confine the dog, and provide for his need to eliminate if you do not have a fence?
During the day?
During the night?
During family absences overnight?
While you are at work?
Where will you keep the dog:
If dog is destructive when left alone?
Do all adults in the house work?
Is someone home during the day?
Maximum hours your dog will be left alone during a 24-hour period?
Do you intend to keep this dog primarily indoors or outdoors?
Where will the dog sleep?
Busy household - visits by friends, in and out a lot, children, parties at home
Please check all that apply in your household:
Noisy - TV, stereo, machinery, tools, children playing, dogs barking
Moderate - normal comings and goings
Quiet - "homebodies", few guests, come home and stay home
Lots of children in the neighborhood
Live on a busy street
Which brand of heartworm prevention do you (did you) use?
Are you aware of the financial responsibilities of dog ownership? Including vet care, good quality food, licensing, inoculations, heartworm and flea preventative, grooming, etc.
Do you understand that the dog you adopt must be kept on monthly heartworm preventative?
Are all of your pets current on vaccinations and heartworm preventative?
What kind of dog food will you feed your pet? Be specific please.
What circumstances, in your opinion, justify getting rid of a dog?
What would you do with the dog if the above circumstances occurred?
What will you do with your dog if you move?
Have you ever surrendered a pet of yours to an animal shelter?
If yes, why?
Have you ever sold or given away one of your pets?
If yes, why?
Are you aware of the fees that our rescue organization charges?
Are you willing to allow a rescue volunteer to do an in-home inspection?
Are you willing to allow this rescue to do unannounced in-home visits to ensure that the dog is being properly cared for?
Thank you for taking your time to complete this application.
By signing below you attest to the truthfulness of your answers.
Falsification of any of the above information will be grounds to disallow your adoption of a rescue dog.
All of the answers I have given are true and correct
to the best of my knowledge
Applicant Signature
Applicant Signature
(Please type full name. If there are two responsible adults in the household, both must sign as applicants.)
If you don't have a response to your application within three days please email us.
