Dog Adoption Application

Dog's name: *

Today's Date *

Adopter's First Name *

Adopter's Last Name *

Email Address *

Street Address *

City *

State *

Zip Code *

How did you hear about us? *

Contact Number *

Occupation/Employer *

Weekly Hours Worked *

How Long at Current Job *

Do ALL adults in your household agree to this adoption? *

Names and Ages of Household Members *

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 *

Relationship to reference? *

Reference email *

How long have you resided in your current location? *

Do you Rent, Own or Live with someone else? *

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 am looking to adopt for the following reason(s): *

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? *

How will you housetrain your dog? *

How will your new pet get exercise?

What is your general philosophy on vet care? *

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? *

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) *