Pet Adoption Form

First name

Last name

Email

Phone

Up until what time of night can we contact you via phone?

Multi-line address

Country/Region

Address

City

Zip / Postal code

How long at this address?

Are you planning on moving within the next 6 months?

Yes

No

If yes, what are your plans for your pets if you move?

Name of employer

Work Phone Number

Are you 18 years of age or older?

Yes

No

Birth Date

Month

Day

Year

Do you own your own home?

Yes

No

If no, name and phone number of landlord

Type of dwelling

Name and age of ALL occupants in household (including yourself)

If no children, do you plan on having children or will children be visiting the household frequently?

Yes

No

If other, please explain

How many total hours will your new pet be left alone during the day?

How many total hours will your new pet be left outside alone during the day?

If adopting a puppy, where would the puppy be kept when alone?

Do you have a fenced yard?

Yes

No

If yes, which type of fence?

Wood

Chain Link

Split Rail

N/A

If yes, how tall is fence?

Do you have locks and/or latches on all your gates?

Yes

No

N/A

Will you put your adopted dogs, or do your current dogs currently get placed on a tie out?

Yes

No

Not Sure

Are any members of your household allergic to animals?

Yes

No

If yes, please describe

Who will have chief responsibility for the care of your pet?

Over the past 5 years, how many pets have you owned? (include current pets)

List each individually including breed, age, still living with you? (if not, why?)

Have you and your spouse (if applicable) ever owned a pet together?

Yes

No

N/A

If yes, when?

Have you ever lost of given away a pet?

Yes

No

If you currently own a dog or cat, how does he/she react to new pets?

Are your present pets up-to-date on their annual vaccinations?

Yes

No

N/A

If no, please explain

Are your present pets spayed or neutered?

Yes

No

N/A

If no, please explain

How much are you financially prepared to spend for routine/emergency medical care, licensing, etc?

What plans do you have for your new pet when you are on vacation?

Which dog(s) are you interested in?

Can/Will you provide your dog with monthly heart worm/flea/tick prevention?

Yes

No

Who is your current or most recent veterinarian? Please provide their NAME and PHONE NUMBER

If your dog displays behavioral problems (such as jumping on people, excessive barking, potty accidents, etc) how would you go about correcting the behavior?

Contact a professional

Use a book

Personal knowledge

Other

If other, please explain

What type of solution would you be willing to try if housebreaking accidents continue after the first week? (check all that apply)

If other, please explain

Is your entire immediate family in agreement with the decision to bring a new pet into your home?

Yes

No

If anyone is NOT, please explain

Are you prepared to commit to a pet for 15 to 20 years (average life span)?

Yes

No

Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?

Yes

No

If yes, please explain

Have you ever adopted or tried to adopt a pet from us before?

Yes

No

Pet's Name

Type of pet

Cat

Dog

Adoption / Application date

If you selected outdoor, would your dog be supervised?

Yes

No

Where will your dog eat?

Where will your dog sleep?

Please provide 2 personal references (only 1 can be a relative) that can testify to your responsibility and ability to care for your animals. This is required for your application to be approved

Reference #1

Phone Number

Reference #2

Phone Number

If there is anything else you think we should know, please note it here

Please remember, it may take approximately 2-3 business days for us to get back to you.

Thank you so much for wanting to rescue a dog!!!