Dog Adoption Application
Please fill out this form honestly, and email RrrrescueMaria@gmail.com with any questions.
All questions must be answered. If they do not apply to you, please write N/A.
Email address *
First Name *
Your answer
Last Name *
Your answer
Age *
Your answer
Driver's License State, # and Expiration Date *
Your answer
Address *
Street Address
Your answer
City and State *
Your answer
Phone Number *
Your answer
We sometimes require home visits. May we visit your home? *
Do you rent or own? *
Do you have your landlord/homeowner's permission to bring a new pet home? *
Your answer
Which dog would you like to adopt?
Your answer
Who will be the primary caregiver for the dog? *
Your answer
Do you know what causes heartworms? *
Your answer
Which heartworm prevention do you use? *
Your answer
Does anyone in your home have allergies or asthma? *
Your answer
Occupation and Employer? *
Your answer
What would cause you to give up a dog? *
Required
Who is your current Veterinarian? *
Your answer
Do you have children? What are their ages? *
Your answer
Do small children often visit your home? *
Are you able to afford yearly vet visits for vaccinations and checkups? *
Are you aware that dogs can live up to 15+ years? Can you care for a dog for that long? *
Your answer
Would you be willing to adopt a dog with special needs? *
(amputated limb, blind, deaf, old age, needs daily meds, etc)
Your answer
If something were to happen to you, who would take care of this dog? Please list a name and number. *
Your answer
Are you able to afford emergency medical attention if needed? *
Your answer
Where will this dog live? *
List any other pets in your home, their species, breed, and age. *
Your answer
When was your last visit to the vet and why? *
Your answer
Have you already gotten supplies for this dog? *
Your answer
How will you deal with behavior problems? *
Your answer
If you have other pets, how will you introduce your new dog to your household? *
Your answer
Where did you find this dog? *
Contract *
Required
Please Type Your Name Below *
By typing your name here, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Your answer
A copy of your responses will be emailed to the address you provided.
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