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Adoption Application
This form is to serve as the adoption application for the dog you are interested in. By filling this out and providing an electronic signature at the bottom you are stating you are not making any false claims. We do perform background checks on all applicants along with the members of your household. The background check searches for criminal records. We are mainly focused on animal abuse charges, not petty crimes. If you would like a copy, please send an email to sheilasrescue@gmail.com.
Animal Information
Name of Dog: *
Your answer
Where did you hear about the dog? *
Your answer
Contact Information
First Name *
Your answer
Middle Name (If no middle name put N/A) *
Your answer
Last Name *
Your answer
Employer *
Your answer
Occupation *
Your answer
Address (No PO Box, this is used for home visit) *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Cell Phone (Put N/A if Not Applicable) *
Your answer
Home Phone (Put N/A if Not Applicable) *
Your answer
Email Address *
Your answer
Date of Birth *
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Family & Housing
How many adults are there in your family (their relationship to you)? Please provide their names and date of birth. *
Your answer
How many children (ages)? *
Your answer
What type of home do you live in single family, town home, apartment, farm, etc.? *
Your answer
Please describe your household: *
If you rent, please give the rules governing pets and the landlord’s name and number: *
Your answer
If you rent, have you paid a pet deposit? *
By providing this information you are allowing us to contact your landlord. Please notify him/her prior to us calling.
Does anyone in the family have a known allergy to dogs? *
Do you have any other pets? If so, please list below. If not, put "N/A". *
Your answer
Are these pets up to date on vaccines? *
Are these pets spayed/neutered? If not, why? *
Your answer
Have you ever surrendered a pet? If so, why? *
Your answer
Have you ever had a pet euthanized? If so, why? *
Your answer
Have you ever lost a pet to an accident? If so, how? *
Your answer
How do you discipline your pets? *
Your answer
Veterinarian Information
Do you have a regular veterinarian? *
Veterinarian’s name: (Put N/A if Not Applicable) *
Your answer
Clinic Name: (Put N/A if Not Applicable) *
Your answer
Clinic Address: (Put N/A if Not Applicable) *
Your answer
Clinic Phone: (Put N/A if Not Applicable) *
Your answer
Providing this information you are allowing SHARe to call your vet. Please provide your vet permission to release information prior to a board member calling.
About the Dog You Wish to Adopt
Where will the dog spend the day? (describe) *
Your answer
Where will the dog spend the night? (describe) *
Your answer
Number of hours (average) dog will spend alone? *
Your answer
Who will have primary responsibility for this dog's daily care? *
Your answer
Who will have financial responsibility for this dog? *
Your answer
Do you agree to provide regular health care by a Licensed Veterinarian? *
What is your monthly budget for your dog? *
Your answer
Do you agree to keep the dog as an indoor dog? *
When the dog goes out, how do you plan to supervise it? *
Your answer
Do you have a fenced yard? *
What type of fence do you have? If you do not have one put "N/A"? *
Your answer
If you decide you do not want the dog, you must return it to SHARe. Do you agree? *
If your application is approved you must consent to a home visit? Do you agree? *
Would you be interested in fostering? *
Personal References
Please list two references.
Name *
Your answer
Address *
Your answer
Phone *
Your answer
Relationship (relative, neighbor, friend, etc.): *
Your answer
Name *
Your answer
Address *
Your answer
Phone *
Your answer
Relationship (relative, neighbor, friend, etc.): *
Your answer
I agree that everything above is true and correct. I understand that by filling out an application I am not guaranteed an approved adoption. If I adopt a dog and decide to return him to SHARe after 10 days, I will forfeit my adoption fee.
Signature *
Your answer
Date *
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