Dog Adoption Application - Rescue K-911
Thank you for your interest in a Rescue K-911 Dog.  Please remember that while we review every application carefully, submitting one does not claim an animal.                                                                                        
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Today's Date *
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Name of Dog(s) you are interested in: *
Your full name:
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Your email address:
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Your full address:
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Your City:
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Your State:
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Your Zip:
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How long have you lived at this address? *
DOB:
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Home Phone:
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Work/Cell Phone:
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Best time to reach you:
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Occupation & Name of Employer:
Name of your Veterinarian:
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Vet Phone Number:
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This Dog will be:   *
Check all that apply
Required
The dog needs to get along with: *
Check all that apply
Required
What type of personality are you hoping for in your new pet? *
Rescue dogs can take 6-8 wks to fully adjust to their new home. What are your expectations of this animal and it's behaviors? *
Household Information: *
Please list the names, ages, and relation of all in the household:
Is anyone in the household allergic to animals? *
Dwelling Information: *
If you rent, what is your landlords policy for pets?
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Do you have a fenced in yard? If so, briefly describe it. *
Example: 4ft chain link, 6ft wood, etc.
Certain breeds and ages of dogs have higher energy requirements. What is your exercise plan, especially if you do not have a fence? *
Have you ever owned a dog before? If so, what particular breeds? *
What pets do you currently own? How long have you owned them? *
Can you please tell us a little about your current pets? (Personality, Temperment, Likes, Dislikes, any disabilities or medications)
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If you currently own a dog/cat, is it spayed/neutered? *
If you currently own animals, are they current on all vaccinations and preventions (Distemper/Parvo, Bordetella, Rabies, Monthly Heartworm & Monthly Flea/tick)?
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If your current pets are NOT up-to-date on vaccines and monthly preventions please explain why:
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Have you ever given a pet away before, to anyone, for any reason?  If so, please tell us about this experience. *
How many hours per day will this pet be WITHOUT human companionship?
Where will the dog stay during the day and during your absences?
Where will the dog stay during the night?
Who will be the primary caretaker of the dog? *
Are you willing to have Rescue K-911 visit your home? *
Personal Reference Information: *
Please supply names and telephone numbers for 3 personal references:
How did you hear about Rescue K-911 or this animal? (ex. Facebook, Instagram, Volunteer etc.)Personal Reference Information: *
* I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that the rescue reserves the right to annul the adoption and reclaim the animal. I give the rescue permission to investigate the information provided, including conducting a background check, as well as contact veterinarians and related officials. I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual pet, and other applications received on this pet. I understand it is the rescue's sole prerogative to decide which home is most appropriate, that my application can be denied at any time for any reason, that their decision is final and I will not contest it. The rescue's goal is to place pets in loving, lifelong homes and any information gathered is used only to that interest. *
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E-Signature *
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