Dog Adoption Application
Today's Date
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Dog's name:
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Adopter's First Name
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Adopter's Last Name
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Email Address
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Street Address
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City
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State
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Zip Code
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How did you hear about us?
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Petfinder
Website
Friend Referral
Facebook
Walkup - Petsmart
Walkup - Petco
Walkup - Other
Online - Petco
Online - Petsmart
Online - Other
Contact Number
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Occupation/Employer
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Weekly Hours Worked
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How Long at Current Job
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Do ALL adults in your household agree to this adoption?
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Yes
No
Names and Ages of Household Members (including yourself)?
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Do you have other pets?
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Yes
No
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?
Yes
No
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.
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Reference Phone number
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Reference email
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How do you know your reference?
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How long have you resided in your current location?
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What type of residence do you live in?
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Apartment/Condo
House
Mobile Home
Other
Do you Rent, Own or Live with someone else?
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Rent
Own
Live with Parents/Guardian
Live with Roommates
Other
If renting, are animals allowed on premise?
Yes
No
If renting, please list name of landlord including phone number
Are you moving soon?
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Yes
No
Do you have a fence?
Yes
No
If yes, please describe your fence (height and type), as well as approximate yard space.
Please select one of the following
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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):
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Companion/Family pet
Assistant/Therapy pet
Protection/Guard Dog
Companion for another pet
Gift
Other
Will the adopted dog live primarily inside or outside?
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Inside
Outside
Combination
If outside, what type of shelter will it have?
Have you ever applied or adopted from another group?
Yes
No
If yes, what organization or person did you work with in the last 5 years?
Have you ever been declined for adoption ?
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Yes
No
If yes, what was the reason?
How many hours will your dog be left alone?
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If your dog will be left alone, where will he/she be left?
How will you housetrain your dog?
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Consult professional
Crate train
Take out every couple of hours
Rub nose in offending spot
Consult professional
How will you discipline your new pet if he/she chews on household items?
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No big deal
Redirect/distract
Swat nose
Spank
Use stern voice
Use a newspaper
How will your new pet get exercise?
What is your general philosophy on vet care?
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Spare no expense
Within budget constraints
Pet insurance
If treatment or care is very expensive, I may need assistance or return the dog
Will you keep your dog on heartworm preventative?
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Yes
No
If no, why?
Which of the following worst case scenario, would you consider giving up your pet?
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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)
Chronic Illness
New baby or plans to have a baby
Dog is not what I thought it would be
Barking/neighbors complaining
Would never give up
In the event that you cannot keep your dog, for any reason, do you agree to return it to Shelter2Rescue?
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Yes
No
Shelter2Rescue Coalition and the representatives of the rescue reserve the right to call and verify care of the adopted pet with the veterinarian?
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Yes
No
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.
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Yes
No
Full name (typed name will be accepted as signature)
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