Name
*
First Name
Last Name
Home Phone
(###)
###
####
Work Phone
(###)
###
####
Cell Phone
*
(###)
###
####
Which number do you prefer we call?
*
Home
Work
Cell
Email Address
*
Your Age:
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How Long At This Residence?
*
Do you rent or own this dwelling?
*
Rent
Own
If you rent, does your landlord know you intend on adopting a dog?
Please list your landlord's name, address and phone number
Your Occupation
Your Employer
Name, Occupation and Employer of Spouse/Significant other
Please list the NAMES, AGES and RELATIONSHIP (to you) of all household members:
*
Are all household members in agreement with adopting?
Who will be the primary caregiver for your new dog?
*
Are you expecting to have children (or more) children in the future?
*
If you have a child/more children in the future, how will this affect the dog's place in the household? Also, how do you plan on introducing the dog to the new family member?
Will any children visit on a regular basis?
*
If so, what age(s)?
Does anyone in the household have pet allergies?
*
If yes, please explain.
We require that all adopters must surrender the dog back to us if for any reason they can no longer keep them. Do you agree with this policy, if you must move in the future and dogs are not permitted in your new residence, or if for any reason you are unable to care for the dog?
*
Do you have a fenced yard? If so, what type of fence and height?
*
How do you plan to properly exercise the dog?
*
Where specifically will you keep the dog when you are away from home?
*
Are you familiar with crate training? What are your thoughts on crate training?
*
Please explain what you will do if your dog displays destructive behaviors:
*
How will you reprimand or correct your dog for unwanted behavior?
*
Please be specific.
What training collars are you comfortable with and which ones do you feel you would best utilize or have you used in the past, if any? (Pinch/prong collar / Choker collar / Electric shock/stim/vibrating/ E-collar? Gentle lead?
*
Are you willing to hire a dog trainer or behaviorist if necessary?
*
How do you feel about dogs lying on furniture or sleeping in bed with you?
*
We attempt to provide all adopters with an honest and thorough evaluation of temperament on every dog in our care. Do you realize that often times a complete history of the dog may not be known and you could encounter some behavioral problems? If so, how will you deal with these problems?
*
What behavioral/training issues can you NOT deal with?
*
Do you know that you may have to house train your new dog?
*
Are you familiar with your local leash/licensing laws?
*
It is our policy to conduct a home visit prior to finalizing the adoption. Is this acceptable to you?
*
We like to keep track of the dog via updates and communication post-adoption. Is this acceptable to you?
*
If applicable, is your landlord aware that you are planning to adopt this particular breed of dog?
Please select age preference:
Why do you want to adopt this dog?
*
Please list the characteristics you find most appealing:
*
(dominant, submissive, shy, confident, aggressive, protective, loving, active, calm, intelligent, playful, independent)
Please list name, age, breed and gender of all CURRENT pets:
Please list name, age and breed of all PREVIOUS pets:
Please include age at passing, cause of death, or why rehomed.
How did you hear about our organization?
*
Petfinder.com
Facebook
Internet search
Friend
Veterinarian
Other
Please list your CURRENT veterinarian's name, address and phone number.
How long have you been a client?
Please list your PREVIOUS veterinarian's name, address and phone number.
How long were you a client? Which pet(s) did they treat?
Do we have your permission to speak with your veterinary references?
Reference 1.
*
First Name
Last Name
Phone
*
(###)
###
####
Relationship to you:
*
Years known:
*
Reference 2.
*
First Name
Last Name
Phone
*
(###)
###
####
Relationship to you:
*
Years known:
*
*
First Name
Last Name
Phone
*
(###)
###
####
Relationship to you:
*
Thank you for taking the time to complete this application! If you have any additional comments please use the space below.
