Adoption Application

Application Received — Thank You!

We will review your application and get back to you within 48 hours.
PLEASE COMPLETE THE ENTIRE APPLICATION — DO NOT SKIP QUESTIONS(write N/A if not applicable). Use tab or click from field to field.
Section 1 — Basic Information
1. Email *
2. Name of pet applying for
3. What personality traits are you looking for in your new companion?
4. Why would you like to own the breed you have selected?
5. Name * (Full first and last name)
6. Maiden name or other variations
7. Birth date
8. Full name of spouse / partner / roommate
9. Birth date
10. Address / City / State / Zip / County *
11. Home phone
12. Cell phone
13. Do you live in a:
14. Do you:
15. If you rent or lease, landlord name and phone number
16. How long have you lived at the above address?
17. Place of employment
18. Occupation or title
19. How long have you been looking for a dog?
20. How many hours each day will this dog be left alone?
Section 2 — Daytime Care
21. Where do you plan to keep your dog during the day? (check all that apply)
22. How many hours per day?
Section 3 — Home & Yard
23. Where will your pet stay at night (be specific)?
24. How big is your yard?
25. Is it all fenced in?
26. Type of fencing
27. Fence height:
28. How are fence gates secured?
29. Will fenced yard access be supervised or unsupervised?
30. Please describe your yard: (Example: Pool w/ Lanai, Pool w/o Lanai)
31. If you have no fence, how will you exercise your pet? (check all that apply)
32. If other, please describe.
Section 4 — Care & Household
33. Who will be responsible for your pet’s care?
34. Who will be responsible for this pet’s financial expenses?
35. How much do you think you will spend on this pet this year? (Include: food, flea and heartworm prevention, vetting and grooming if necessary)
36. How many children live with you?
37. Please list ages of children:
38. How many children visit you regularly (include ages)?
39. Do you have any roommates? If so, how many?
40. Does anyone in your family have a history of a pet allergy? If so, how is it controlled?
41. What do you know about heartworm / flea prevention?
42. If animal is a pit bull, is this your first time owning a pit bull?
43. If animal is a pit bull, of all breeds available why do you want a pit bull?
44. Have you ever had an animal impounded / picked up by animal control? If yes, please explain.
45. If yes, was animal reclaimed? If not, please explain why.
Section 5 — Pet History & Training
46. Have you ever sold, surrendered or given away a pet? If yes, please explain in detail.
47. Describe pets that you or your current partner (adult who lives with you) have owned in the past ten years. Do not include childhood pets or pets owned by your parents. Include: name and type of dog, age, sex, spayed or neutered, kept inside or outside, how long owned, and what happened to pet (or still have).
Name / Type of Dog
Age
Sex
Spayed / Neutered
Kept Inside or Outside
How Long Owned
What Happened to Pet (or Still Have)
48. If your pet did have a behavior problem, what would you do? (check all that apply)
49. How much time are you willing to give this pet to adjust to its new environment?
50. This animal may not be housebroken or may be only partly housebroken. Are you willing to take the time to work with him / her?
51. How would you react if this pet had a potty accident in the house?
52. A newly fostered or adopted dog or cat may want to spend as much time with his / her new family as possible during their transition into your home, and may want to sit on the sofa or sleep in bed with you. How do you feel about this?
53. If your new pet wants to be on your furniture, how will you handle this?
54. Do you plan to seek obedience training?
55. Why or why not will you seek obedience training?
56. If pet is a dog, will you crop its ears and / or tail?
Section 6 — Vetting, References & Employment
57. Who is the veterinarian or veterinarians who have provided care for your current and previous pets?
58. How do you feel about spaying / neutering?
59. When you go on vacation, who will care for your pet?
60. Why do you want this pet?
61. What reasons would cause you to consider giving your adopted pet back, or cause you to no longer be willing to commit to him / her? (check all that apply)
62. Reference #1
63. Reference #2
64. Employer
65. Position or title
66. Complete address
67. How long have you been with this employer?
68. Work phone
69. Is there anything else you would like to tell us or ask us?
Section 7 — Agreement
Thank you for your interest in adopting and saving a life! Our goal in rescuing animals is to provide them with a loving home for the rest of their lives. Upon receipt of your completed application, it will be reviewed and we will get back to you within 48 hours. The adoption fee covers part of the medical costs associated with this animal. The rescue reserves the right to refuse adoption for any reason in the best interest of the dog. I verify that I have answered all questions truthfully. If any information in this adoption application is found to be false, we will send an email with an opportunity to make corrections. If we do not hear back with corrections within 48 hours, we will close your application. If any information comes to light as false after adoption, we may confiscate the adopted animal. We reserve the right to refuse placement of any animal. We require a home visit and require that all members of the family, including other pets, visit with this animal prior to adoption.
Signature (typed name accepted):
Date:
Thank you for contacting rescue!