Adoption Application
Animal you are interested in adopting
Blue (Dog - D2021002)
Karma (Dog - D2020002)
Katara (Dog - D15Y001)
Peyton (Dog - D18Y011)
Applicant's First Name
Applicant's Last Name
Street Address
City
State
Apartment Number (if applicable)
Zip Code
Phone Number
Email Address
Alternate Phone Number
If you have social media, what is your username? (For example: Facebook- John Smith)
Date of Birth (Must be 21 years of age to apply)
*
How did you find out about us?
Petfinder
Internet Search
Family/Friend
Staff/Volunteer
Facebook/Twitter
Other
Is this pet for you or someone else?
Myself
Someone else
Do you own other pets at the current time?
No
Yes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?
Yes
No
N/A
How many pets have you owned in the last 5-10 years?
What happened to them?
Are your pets current on their vaccinations?
Yes
no
n/a
Have you ever turned your dog or cat into a shelter?
No
Yes
If yes, please explain?
Veterinarian's Name
*
Veterinarian's Address, City, State, and Zip Code
Veterinarian's Phone Number
Have you ever had a pet euthanized?
No
Yes
If yes, please explain:
How do you feel about having pets spayed/neutered?
Agree
Disagree
Not Sure
Do you use heartworm prevention? If so, what brand?
If you have pets, will they adjust to a new pet in the house?
Yes
No
Unsure
N/A
Please check the main reason you plan to adopt a pet:
Companion
Family Pet
Child's Pet Guard Dog
Companion for another pet
Other
If you answered "other" above, please explain here:
Describe the personality of the pet you are looking for. (Do not put a name, describe the physical appearance, or copy paste our description. We are asking what kind of pet YOU want, not a description of the dog in our care. i.e. Energetic, smart, laid-back, etc.)
Do you own or rent your home?
Own
Rent
Someone else owns the Home
Someone else rents the Home
Please select your current residence type.
House
Apartment
Condo
Townhouse
Mobile Home
Other
If you answered "other" above, please explain here:
How long have you lived at this address?
Less than one month
1-2 months
3-6 months
6-9 months
9-12 months
1-2 years
3-5 years
6-10 years
10 + years
If you rent, does your landlord and lease allow pets?
Yes
No
Unsure
N/A
Does your landlord/lease have breed restrictions?
No
Yes
If you answered "yes" above, what breeds are restricted
Including yourself, how many people live in your household?
Please list the ages & relationship of those who live in your home.
Is everyone in your household aware that you are planning to adopt a pet?
Yes
No
N/A
Does anyone in your household have allergies to dogs/cats?
Yes
No
Possibly
N/A
On average, how many hours per day will your pet be left alone?
How much do you think the annual medical bills will be for your pet?
About $100
$100 - $200
$200 - $300
$300 - $500
$500 +
What would you do if the bills went over this amount?
Will this pet be predominantly living inside, outside, or both?
Inside
Outside
Both
Please provide a description of this pet's living conditions.
Do you have a completely fenced-in yard? If so, what kind of fence?
Wood
Chain Link
Electric
Plastic
Iron
Other
Other (I do not have a fenced yard)
If you answered "other" above, please explain:
If you do not have a fenced yard, how will you let the animal out?
Are there times when the animal will be tied/chained up?
Yes
No
N/A
If yes, when will they be tied/chained up?
Where will the animal sleep?
In bed with me
In bed with my child
In a dog / cat bed
In a kennel / crate
Wherever he or she likes
Outside
Other
If you answered "other" above, please explain:
Will the animal spend any time in the garage?
Yes
No
N/A
If the animal will spend time in the garage, please explain when/why:
How will you handle housebreaking?
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?
No
Yes
If no, please explain:
Are you willing and able to exercise the dog on a regular basis?
Yes
No
N/A
If yes, what is the method of exercise?
Walking
Running
Dog Park / Dog Run
Other
If you answered "other" above, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?
No
Yes
If yes, please explain:
If you drive a pick up truck, would you allow the animal to ride in the back/bed?
Yes
No
N/A
What arrangements will you make for the care of your pets in case of an emergency?
Leave with family/friend
Boarding
Pet Sitter
Take with me/us
Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?
Leave with family/friend
Boarding
Pet sitter
Take with me/us
Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
What would you do with your animal if you had to move?
Take him / her with me
Give to family or friend
Return to shelter
Other
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?
No
Yes
If no, please explain:
Will you allow us to perform home checks? If you answer no to this question, your application will not be considered.
No
Yes
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal, although as much information is given on the animal as is possible for us to know in a rescue setting, and that all precautions have been taken to insure proper health.
*
Yes
No
If approved, you will be contacted via email. You will be given 24 hours to respond before we move on to the next application. Please confirm your email.
*
Comments (Are there other animals you are interested in)