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Adoption Application
Adoption Application
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* Indicates required question
Name of dog interested in adopting
Your answer
Today's Date
*
MM
/
DD
/
YYYY
Name
*
Your answer
Email
*
Your answer
Address (Please include Street, City, State, Zip)
*
Your answer
Phone number
*
Your answer
Reference #1: Veterinarian Information - Name, Location and phone number.
*
Your answer
Reference #2: Please provide name, location, phone number of someone who knows you well and is not related to you.
*
Your answer
Reference #3: Please provide the name, location, and phone number of a family member.
*
Your answer
Do you have a particular type of dog you are looking for?
*
Yes
No
If Yes, please specify: Size, Gender
S
M
L
Male
Female
If you indicated preferences, are you flexible?
Yes
No
Clear selection
Are you willing to adopt a dog that: (choose all that apply to you)
*
Has been abused and therefore may be anxious or may take a while to warm up to you?
Is not completely housebroken?
Is not reliable with children?
Has a physical deformity or handicap?
Requires ongoing medication for a medical condition?
Required
Do you have a fenced in yard?
*
Yes
No
If yes, describe the type of fencing:
*
Your answer
If No, what type of containment will you use?
Your answer
Do you own any pets?
*
Yes
No
Pet #1 Name, Species, Breed, Age?
Your answer
Spayed/Neutered?
Yes
No
Clear selection
Pet #2 Name, Species, Breed, Age?
Your answer
Spayed/Neutered?
Yes
No
Clear selection
Pet #3 Name, Species, Breed, Age?
Your answer
Spayed/Neutered?
Yes
No
Clear selection
Pet #4 Name, Species, Breed, Age?
Your answer
Spayed/Neutered?
Yes
No
Clear selection
Please describe each of your pets' personalities?
Your answer
If you own cats, have they been exposed to dogs?
Yes
No
Clear selection
Have you ever owned a dog that is no longer living with you?
*
Yes
No
If Yes, what happened to the dog?
Your answer
Please describe what you know or assume about the special needs of rescue dogs.
*
Your answer
What healthcare do you or your vet provide for your pets?
Your answer
About how much would you expect to spend annually on medical care for a dog?
*
$100
$250
$500
$1000
$1000+
Please list your age, and the names, ages, and relationships of all the people living with you.
*
Your answer
How often, on average, do other people visit your home? Explain briefly how you will introduce visitors to your dog.
*
Your answer
How have you taught your children (or how would you teach visiting children) to interact with a dog?
*
Your answer
Who will be the primary caregiver for this dog?
*
Your answer
Who will care for the dog when the primary caregiver is away - at work or on vacation?
*
Your answer
How many hours will the dog be left at home alone during the day, and where will the dog be kept during those hours?
*
Your answer
Do you own your home or rent?
*
Own
Rent
If you rent, is your landlord agreeable to having a dog?
Yes
No
Clear selection
Provide name and phone number of landlord.
Your answer
Where will the dog sleep?
*
Your answer
Describe how you will feed your dog.
*
Your answer
How will you provide exercise for your dog?
*
Your answer
How did you hear about Rusty's Angels?
*
Your answer
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