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Good Karma Rescue Adoption Application
Montpelier, VT ~ 802-595-5110 ~
goodkarmarescue@gmail.com
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* Indicates required question
Email
*
Your email
Name of the Animal you're interested in
*
Your answer
Your Information ( Please include all adults full names):
Names of all adults:
*
Your answer
Street Address:
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Your answer
City:
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Your answer
State:
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Your answer
Zip Code
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Your answer
Home Phone:
Note: If you do not provide a home, cell, or work number, the application will be discarded.
Your answer
Cell/Work Phone:
Note: If you do not provide a home, cell, or work number, the application will be discarded.
Your answer
Best Time to Call:
Your answer
Occupation:
Your answer
Tell us briefly about yourself and the activities you would enjoy doing with a dog:
Your answer
About Your Residence
If you live in an apartment or co-op you must provide the name and phone number of your landlord or managing company. Please be sure to alert them to our call.If this information is not provided, the application will be discarded.
Type of home in which you live:
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Single Family
Apartment
Condominium
Trailer
Other:
Do you own or rent your residence?
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Please be prepared to provide proof of home ownership.
Own
Rent
Other:
If you rent - Landlord's Name and Contact: Landlords are called. Please alert them.
Your answer
How long have you lived at this address?
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Your answer
Do you have a fenced yard?
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Yes
No
Fence Type/Height?
Your answer
If yard is not fenced how do you plan on exercising the dog/bathroom breaks?
Your answer
Household Information
How many adults in household?
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Your answer
How many children/Ages?
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If none, please type "none".
Your answer
Are all family members aware of & in agreement about adopting a dog?
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Your answer
Are there regular visitors to your home (human or animal) with which your new dog must get along? Please describe.
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Your answer
Current animals in the home (include hoofed animals)
Type / Name / Age / Sex / Altered?
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Please provide Characteristics (friendly/dominant/shy). If none, please type "none".
Your answer
Please list any animals that you have had in the past 5 years and reason they are no longer with you:
Your answer
Veterinarian Reference
Please provide the name of your regular Vet. Please be sure to alert them to our call. It’s actually a good idea to call them to be sure your animals are all set too. VET PHONE NUMBER IS REQUIRED, VET REFERENCES ARE CALLED. Please call your vet IMMEDIATLY after applying to alert them.
Veterinarian Phone:
Your answer
Veterinarian Name:
Your answer
How long have you been using this office?
Your answer
If you have been a guardian to a dog or cat in the last 10 years and do not have a regular vet, please give a reason why:
Your answer
Personal References NOT related to you(#1)
Name:
*
Your answer
Relationship:
*
Your answer
Daytime Phone:
Your answer
Evening Phone:
Your answer
Best time to call:
*
Your answer
Email:
Your answer
Personal Reference (#2)
If no vet reference please include a second personal reference
Name:
Your answer
Relationship:
Your answer
Daytime Phone:
Your answer
Evening Phone:
Your answer
Best time to call:
Your answer
Email:
Your answer
Other Information:
Have you ever surrendered an animal to a shelter, rescue group, or given one away?
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Yes
No
If yes, describe the circumstances:
Your answer
Will you have your dog on a run, or trolley, or tied out at any time?
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Yes
No
Other:
If yes or other, please explain when and for how long:
Your answer
How do you plan to do training with this dog?
Your answer
On average how many hours will the dog stay alone each day?
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Your answer
Where will dog spend the day?
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Be specific - crate, loose etc.
Your answer
Where will dog spend the night?
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Be specific - crate, in bedroom, yard etc.
Your answer
What specific personality traits/behaviors are you looking for in a dog?
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Example: calm, active, already trained etc.
Your answer
How did you hear about this dog?
*
Your answer
If you are approved by another rescue please provide the name:
Your answer
Please send an email upon completion of this application. COMPLETION AND SUBMISSION OF THIS APPLICATION AUTHORIZES GOOD KARMA RESCUE TO CALL REFERENCES. WE RESERVE THE RIGHT, IN OUR SOLE DISCRETION, TO REFUSE ANY APPLICANT FOR ANY REASON WHATSOEVER.
A copy of your responses will be emailed to the address you provided.
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