Dog Adoption Application
Adopter's First Name
Adopter's Last Name
How did you hear about us?
Walkup - Petsmart
Walkup - Petco
Walkup - Other
Online - Petco
Online - Petsmart
Online - Other
Weekly Hours Worked
How Long at Current Job
Do ALL adults in your household agree to this adoption?
Names and Ages of Household Members (including yourself)?
Do you have other pets?
List your other pets, including name, age, sex, and whether they are neutered/spayed
Have you ever owned any animal other than the one listed above?
If Yes, what kind of animal and when?
What happened to the animal
What is the name, address, and phone number of your current veterinarian (if applicable)?
A personal reference is required. Please list the name and relationship of a reference we may contact. Please let them know we will be calling.
Reference Phone number
How do you know your reference?
How long have you resided in your current location?
Do you Rent, Own or Live with someone else?
Live with Parents/Guardian
Live with Roommates
What type of residence do you live in?
If renting, are animals allowed on premise?
If renting, please list name of landlord including phone number
Are you moving soon?
Do you have a fence?
If yes, please describe your fence (height and type), as well as approximate yard space.
Please select one of the following
I have had animals my whole life (experienced owner)
I have worked with animals my whole life and am actively looking for the perfect companion (ready to own)
I have loved animals but never owned (novice)
I am looking to adopt for the following reason(s):
Companion for another pet
Will the adopted dog live primarily inside or outside?
If outside, what type of shelter will it have?
Have you ever applied or adopted from another group?
If yes, what organization or person did you work with in the last 5 years?
Have you ever been declined for adoption ?
If yes, what was the reason?
How many hours will your dog be left alone?
If your dog will be left alone, where will he/she be left?
How will you discipline your new pet if he/she chews on household items?
No big deal
Use stern voice
Use a newspaper
How will you housetrain your dog?
Take out every couple of hours
Rub nose in offending spot
How will your new pet get exercise?
What is your general philosophy on vet care?
Spare no expense
Within budget constraints
If treatment or care is very expensive, I may need assistance or return the dog
Will you keep your dog on heartworm preventative?
If no, why?
Which of the following worst case scenario, would you consider giving up your pet?
Death of owner/loved one
Divorce or separation
Large vet expense
Loss of bladder control
Dog nips at stranger or family members
Out of state move or new residence where pets are not allowed
Dog and current pets/family member incompatible
Allergies to pet (self or family member)
New baby or plans to have a baby
Dog is not what I thought it would be
Would never give up
In the event that you cannot keep your dog, for any reason, do you agree to return it to Shelter2Rescue?
Shelter2Rescue Coalition and the representatives of the rescue reserve the right to call and verify care of the adopted pet with the veterinarian?
I hereby agree to hold Shelter2Rescue Coalition, Inc and it's representatives harmless against any and all claims, damages, cost, expenses, or other items pertaining to dog that is being adopted, or anything resulting from or caused by the adopted dog.
Full name (typed name will be accepted as signature)