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Application to Adopt / Foster 2 Adopt
This is STEP ONE and MUST be completed in order to move forward with adopting any pet from Countryside Animal Rescue.
The following information is requested so we may assist you in the selection of a new dog. This application and a consultation with an Adoption Counselor are designed to help you find the dog most compatible with your family and lifestyle.
If we have a dog that has an excessive amount of interest, we will review each application and notify you if you have been chosen as best fit for the dog.
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Email
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Your email
Today's Date:
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MM
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DD
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YYYY
Name
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First and last name
Your answer
Mailing address, City, State, Zip
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Your answer
Phone number
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Your answer
Email Address
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Your answer
Occupation:
Your answer
Animal you are interested in?
Your answer
Is this dog a gift?
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Yes
No
Is this dog for a family companion/emotional support/watch/protection dog?
Your answer
What breed are you interested in?
Your answer
What age and size are you looking for?
Your answer
What activity level would you like the dog to be?
Low
Moderate
Active
Very active
Clear selection
Please list the names and ages of the people living in your home.
Your answer
Do you own or rent or live with parents/roommates?
Own
Rent
Parents / roommates
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Type of home?
House
Condo
Apartment
Mobile Home
Clear selection
How long have you lived at this address?
Your answer
What is your household activity level?
Low
Moderate
Active
Very active
Clear selection
List breed and age of pets currently living in your home.
Your answer
Have you owned a dog before? Breed?
Your answer
Will your dog have indoor/outdoor access?
Yes
No
Clear selection
Who will be responsible for feeding the dog every day?
Your answer
How many hours per day will the dog be home alone?
Less than 3 hours
3 - 6 hours
6 - 9 hours
More than 9 hours
Clear selection
Where will the dog stay when you are not home?
Your answer
Who will take care of the dog when you are on vacation?
Your answer
If you have to relocate, what will you do with your dog?
Your answer
Who will provide the daily exercise that dogs need?
Your answer
In what family activities will your dog be included?
Your answer
Do you have a secured fenced yard?
Yes
No
Needs repairs
Clear selection
Do you currently have a Veterinarian?
Yes
No
Clear selection
What is your Veterinarian's name? May we contact for a reference?
Yes
No
Clear selection
What type of identification will your dog wear?
Your answer
We strongly advise enrolling in a dog obedience class? Do you plan on taking your dog to obedience classes ?
Yes
No
I would like a referral
Clear selection
Who will be responsible for training your dog?
Your answer
What type of training technique and equipment will you use?
Your answer
Do you plan to socialize your dog?
Yes
No
Clear selection
Please describe what you would do if your dog develops any of the following behavior problems: barking, chewing, aggression, inappropriate urination in the home.
Your answer
How did you hear about Countryside Animal Rescue?
Your answer
We are a small but MIGHTY team working hard to match families with the perfect family companion.
Each application will be reviewed as quickly as possible. After reviewing your application, you will be contacted if we feel you are a good fit and a Meet & Greet will be scheduled.
We will post as much information as we know about each pet in our care. We ask that you read and carefully consider the needs of each animal before sending over this form.
Thank you,
Countryside Animal Rescue Staff
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