ADOPTION APPLICATION NOTE: You must be over 21 to submit an application Date: CONTACT INFORMATION
First Name: Street Address 1: PO BOX Address 2: City/State: Daytime Phone: Cell Phone: Place of Employment: Email: Spouse's/Partner's Name: Roommates name(s) 1:_______________________ 3:_______________________ 2:_______________________ 4:_______________________ Zip: Evening Phone: Work Phone: Last Name:
Dog's Name:
Why do you want to adopt a dog? Please check ALL that apply: Family Pet _____ Childs pet _____ I want my child to learn responsibility and a pet is a good learning experience_____ Gift : __ If gift for whom and why: __________________________________________________________________ Hunting Dog _____ Guard dog ____________ Home___________ Business___________ Companion _____ Companion for current pet ____ Other (please specify): __________________________________________________________________ Current Living Situation
Do you live in: house ____ mobile home_____
apartment _____
condo/town home ____
Do you rent or own your home? __________ If you rent, name and contact number for your landlord: ___________________________________________ Do you have your landlords approval to have pets? _____YES
_____NO
What is the pet deposit? __________ Are there any breed or weight restrictions?____________________________________ How long have you lived at your current address? _______________ Is there a fenced yard? Yes ________ No__________ If yes please indicate type of fence (height, style, etc.): ________________________ Are you planning on moving within the next two years? _____________ If yes, explain: _______________________________________________________________________ How will you provide exercise for your new pet?______________________________________________________________________ _________________________________________________________________________ __________________ How many adults are living in your home? _________ How many children?: ___________________________ Ages: ___________________________ If you do not have children, do you have children that visit your home? _________ Please indicate their ages: __________ Does everyone in the family know that you are considering adopting a dog? Yes _____ No_____ Is there anyone in your home with pet allergies? _______________________________ Do you foresee any major changes in your life in the next 15 years, (average life span of a dog), such as marriage, children, health problems, going away to college? If yes, explain. Pet History Do you currently have a pet? Yes ______ No _____
If you responded yes to the question above, please describe the pets current circumstances and temperament:
If you currently do not have pets, but have in the past please respond to the statement below: Please indicate the species, breed (if applicable), sex and age of your current/former pets. Please explain what happened to your former pets and where they are now. Include dates etc... Have you ever had a serious behavior problem with a previous pet? describe and explain outcome. If yes, please
Were all previous pets spayed/neutered? How do you feel about spaying/neutering your pet? Has a dog died on your premises of distemper, parvo or unknown causes? Will this be your first dog? Yes _____ No_____
Have you ever tried to adopt from another rescue group or humane society? Yes _____ No_____ If yes, what was the outcome?
Pet Care Philosophy What type of collar/harness do you have on your dog now? What type of collar/harness do you plan on providing for your new dog? What kind of preventative medical care do you or will you provide for your dog? What would you consider a realistic cost to properly care for a dog for one year? _________________________ What is your vets name and number? ________________________________________________ Or past vet? __________________________________________________________________ Are your current animals up to date on vaccines? Daily Routine Approximately how long will the new dog be alone during the day? _______________ Where does your current or where did your past dog stay during the day when you are gone? Goes to work with me ______ Outside in a fenced area _____ Outside in a dog pen _____ Outside on a chain or stake _____ In a crate indoors _____ In the basement _____ Yes________ No_________
In the garage _____ Free run of the house _____
Baby gated in one-two rooms _____
Indoor/Outdoor (has access to the yard via a doggy door)_____ Other (please describe): ___________________________________________
Where will the new dog stay when you are gone during the day? Goes to work with me ______ Outside in a fenced area _____ Outside in a dog pen _____ Outside on a chain or stake _____ In a crate indoors _____ In the basement _____ In the garage _____ Baby gated in one-two rooms _____ Free run of the house _____ Indoor/Outdoor (has access to the yard via a doggy door) _____ Other (please describe): ___________________________________________ Will your dog be allowed on the furniture? Certain pieces _______ Yes_____ No_____
Where does your current or where did your past dog sleep at night? In a crate in the bedroom _____ Doghouse in fenced area _____ Basement _____ Free run of the house _____ Your bed _____ Doghouse with tie-out _____ Garage _____ One room in house _____
Where will your new dog sleep at night? In a crate in the bedroom _____ Doghouse in fenced area _____ Basement _____ Free run of the house _____ Your bed _____ Doghouse with tie-out _____ Garage _____ One room in house _____
What percentage of time will the new dog stay in the house? _____________________________ Where will the dog stay when you go out of town? ______________________________________________________ Are you aware of state and local ordinances concerning pet licensing and leashing? Yes_____ No_____ I would allow my dog off leash in the following situations: In a quiet subdivision ____ On unfenced property with a lot of acreage _____ At the beach ____ Invisible or electric fence _____ When I know that s/he is trained to stay within the set boundaries ____ Never _____
House Breaking and Training What type of house training methods will you use? _________________________________________________ Do you have any experience crate training a dog? _________________ If you dont have a crate, will you be willing to purchase one if the new dog needs to be crated? ____________________ Will you enroll this pet in obedience training? Yes _____ No_____
How would you handle adjustment/training problems such as: Jumping on furniture _____________________________________________ Jumping on People____________________________________ Barking_____________________________________________ Chewing____________________________________________ House Soiling________________________________________ Special Circumstances What circumstances are acceptable to find your dog another home? Check all that apply : ____ Moving ____ New baby, no time for dog ____ Not getting along with other pets ____ Divorce ____ Getting out of fence ____ Behavior problems ____ Shedding ____ Children not helping to care for dog ____ Increased work hours ____ Allergies ____ Not housebroken ____ Medical problems ____ Barking ____ Gets too big ____ Not getting along with children ____ Aggressive ____ Want to travel ____ Not enough time for the dog Other______________________________________________________________ ____ None of the above Have you ever given a pet up? If yes, explain the circumstances.
Most pets require time to adjust to their new home. this pet? ______________
How much time are you willing to give
Please provide three personal references (not relatives) :
Please give all area codes.
Name Name
________________________________ Phone no. ________________________________ Phone no.
____________________ ____________________