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