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Dog Adoption Registration
Dog Adoption Form
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* Indicates required question
Email
*
Your email
Your Name
*
Your answer
Co-Applicant
Your answer
Who Are You Applying To Adopt?
Your answer
Address with Unit or Lot Number
*
Your answer
City, State and Zip Code
Your answer
Phone Numbers
*
Your answer
Are you at least 18 years old
*
No
Yes
Primary Caretaker of Pet
*
Your answer
Three References with Their Phone Numbers
Your Relationship. Only 1 Relative Please
*
Your answer
Is this animal intended to be a gift?
*
Yes
No
Number of Children in Home with Ages
*
Your answer
How Many Pets Have You Had in Last 5 Years? If Not with You Where Are They?
*
Your answer
Do You Own or Rent? (confirmed in assessor records)
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Your answer
If Renting We Need Your Landlords Name and Phone Number
*
Your answer
Do you know of any pet restrictions in your community or home (such as in a rental agreement)?
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Your answer
Are you and your family prepared for possible chewing, clawing, scratching, etc.
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Yes
No
Maybe
How many hours a day would the pet be alone?
*
Your answer
Who is your present Veterinarian or intended Veterinarian? Vets name, clinic name and phone number.
*
Your answer
Do you plan on keeping your dog indoor, outdoor, both?
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Your answer
If after all training options have not stopped the negative behavior what would you do?
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Your answer
Are there any conditions in which you would surrender your pet?
For example, Allergies, cries too much, chews on
things, unruly behavior, bites someone, other. Please explain.
*
Your answer
Are you financially prepared to provide any/all care needed for this pet to live a long & healthy life? Will you commit to this animal for a possibility “up to 20yrs”
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Yes
No
Maybe
Do all members of your family support the adoption of this animal?
*
Yes
No
How do you intend to “discipline” or correct the new pet?
*
Your answer
What behavior do you see “unacceptable” and deem justified to return the dog to the rescue?
*
Your answer
Do you have a fenced yard? If yes what type of fence, how tall?
*
Your answer
What’s your activity level for your lifestyle?
*
slow and easy
moderate activity/ daily walks
very active/on the go
If you do not have a fence are you willing to fence in your yard before you get the dog?
*
Yes
No
Maybe
What is your plan for vacations/emergencies/ or your untimely demise for the care of the animal? Do you have a back up plan?
*
Your answer
Do you promise to get your animals vaccinated when they are due?
*
Yes
No
If you ever need to move, what do you plan on doing with your animals?
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Your answer
Is this your first pet? If Not continue with application Yes skip to signature
*
Yes
No
How many pets do you have now? What are the ages and personality types.
*
Your answer
Will all the family members be home when the rescue makes their “home check”? If No please explain -
*
Your answer
Do you currently have any pets with major health problems or behavioral issues?
*
Your answer
Are your current animals “up to date” with their vaccines? If not, please explain why?
*
Your answer
Are your current animals spayed/neutered? When /where? If not please explain why not?
*
Your answer
Is your current dog/dogs on heart worm prevention What kind, brand?
*
Your answer
Have you ever experienced a pet dying? If yes dog/cat? where/when? Date & Cause:
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Your answer
Have you ever surrendered a pet before? Why & When?
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Your answer
Have any of your pets ever run away? If yes, what did you do
*
Your answer
Application Date
*
MM
/
DD
/
YYYY
Signatures
*
Your answer
A copy of your responses will be emailed to the address you provided.
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