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Adoption Application
Application
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* Indicates required question
Email
*
Your email
Name
Your answer
Co-Adopter
Your answer
DOB
MM
/
DD
/
YYYY
Occupation
Your answer
Street Address
Your answer
City
Your answer
State
Your answer
How long at address
Your answer
Best time to call?
Your answer
Cell Number
Your answer
Home Number
Your answer
Name Of Dog Applying For:
Your answer
Number of Children:
Your answer
Ages:
Your answer
What type of home do you live in single family, town home, apartment, farm, etc.?
Your answer
If you rent, please give the rules governing pets and the landlord’s name and number: (by providing this information you are allowing TRI STATE ALL BREED RESCUE to contact your landlord please inform them of this call so they will speak with us)
Your answer
Do you have a fenced Yard?
Your answer
When the dog goes out, how do you plan to supervise it? Fenced yard?
Your answer
How many hours will the dog be left alone:_
Your answer
Where will the dog stay during this time?
Your answer
Where will the dog stay at night:
Your answer
Does anyone in the family have a known allergy to dogs?
Your answer
Is everyone in agreement with the decision to adopt a dog?
Your answer
What other pets do you have (specify type and number)?
Your answer
Veterinarian’s name:
Your answer
Clinic Phone: (Providing TRI STATE ALL BREED RESCUE with this information you are allowing TRI STATE ALL BREED RESCUE to call your vet. Please call your vet and ask them to authorize the release of information to TRI STATE ALL BREED RESCUE.)
Your answer
What is your idea of an ideal dog and why?
Your answer
Desired age:
Your answer
Desired Size:
Your answer
Desired breed:
Your answer
Desired sex: _ Spayed Female _ Neutered Male _ No preference
Your answer
Do you agree to contact TRI STATE ALL BREED RESCUE if you can no longer keep this dog?
Your answer
Please list someone who is familiar with both you and your pets.
Your answer
Please list someone who is familiar with both you and your pets.
Your answer
Name:
Your answer
Address:
Your answer
Phone:
Your answer
Relationship (relative, neighbor, friend, etc.):
Your answer
Groomers Name:
Your answer
Phone Number:
Your answer
All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.
(signature)
Your answer
Date
MM
/
DD
/
YYYY
Send me a copy of my responses.
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