Adoption ApplicationPlease fill out ALL fields. Name of Applicant * First Name Last Name Additional Applicant Names *if applicable Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone Number * Age of Applicant * Name of the dog you would like to adopt Who will be the primary caretaker of this dog? * How many people reside in your home? * Do you or a member in your household drive? Yes. I have a car. No I do not drive. Yes, but do not have a car. No I do not drive but I have people who can help me. Please select the energy level that BEST describes your household * Average Quiet Loud What type of residence do you live in? * House Town House Condo/Apartment Mobile Duplex Basement Suite Other If you rent, do you have the landlord's permission to own a dog? * Yes No N/A Landlord's Name * Landlord's Phone Number * How long have you lived at your current residence? * Are you planning to move in the near future? * Yes No N/A When will you be ready to adopt this dog? * Today This weekend Within a week Within a month Not ready yet, just researching Do you have a yard? * Yes, I have a yard with a vertical fence Yes, I have a yard with invisible fencing Yes, I have a yard but no fence No yard If fenced, how high? 4 feet 5 feet 6 feet Only partially fenced Do you live on a busy street? * Yes No Do you live near a park, school, walking trails? Please explain. * Is anyone in your home allergic to dogs? * Yes No Does anyone in your home fear dogs? * Yes No Do you currently have any pets in your home? * Yes No If you have pets, please list their breed and age Are your pet spayed/neutered? Yes No Do you have experience with dogs? * Yes No A little Please explain * Do you plan on using a crate? * Yes No Unsure Do you work outside the home? * Yes No One applicant works from home On an average day, how many hours will the dog be left alone? * 1-2 hours 2- 4 hours 4-6 hours 8 or more Have you discussed this adoption with all members of your household? * Yes No If you work full time, are you able to come home during the day to let the dog out for a pee break? Yes No Will arrange doggy daycare Have you had experience handling dogs that have presented any of the following? Please check all that apply. * Aggression towards other dogs/animals Food aggression Separation Anxiety Fear (new people, noises, dogs, etc.) On leash reactivity (dogs, bikes, cars, etc.) Bathroom accidents in the house Escaping/jumping the fence Barking Chewing Puppy behavior Please take the time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or any time during the life of the dog. Please check all that apply * Housebreaking Chewing Jumping Pulling on a leash during walks Counter surfing Fear of Men Fear of Women Obedience Training Mouthiness (may sometimes snag your hand/arm instead of the toy and will need redirecting/training) Growling Barking Rough play with other dogs High activity level Food/toy aggression/not willing to share with other dogs Food/toy aggression with people Whining or crying Blindness Deafness Separation anxiety Diabetes Special diet Long term medication Incontinence/leaking urine Taking classes with the dog Gets stressed/car sick during travel Doesn't know how to climb stairs/nervous around shiny floors Can't climb stairs due to age, arthritis or health issues Skin allergies Food allergies Ear mites Fleas I will do whatever it takes to help the dog adjust and work with a trainer if necessary Please describe how you and your family would handle the following: the dog is having accidents in the house * Please describe how you and your family would handle the following: the dog is chewing on your personal belongings, such as shoes or furniture * Please describe how you and your family will handle the following: your lifestyle has changed and you dont have as much free time for the dog as you used to * Please describe how you and your family would handle the following: you and your spouse part ways * Please describe how you and your family will handle the following: you are having a baby * Please describe how you and your family would handle the following: you suddenly have to move * What type of activities do you plan on doing with your new dog? * Walking Running Hiking Going to the beach Camping Backyard play Agility exercises Dog Park Doggy Daycare Have you ever had to surrender or rehome a pet in the past? If so, what were the circumstances. * Under what circumstances would you consider returning this dog back to our rescue? * Under what circumstances would you euthanize your pet? * Are you prepared to keep this pet for the rest of its life? * Yes No Unsure What would your fantasy dog be like? (If the dog you selected is not the best fit, we can recommend another that is) * How much do you feel you can reasonably afford to spend per year on your dog? * What activity level do you prefer in a dog? * Wild and crazy is cool Leash trained Daily jogging partner Medium energy, plays a bit then hangs out with me Low energy, short walks and a couch potato Please check all that apply: I want to adopt this dog... * As a family pet To breed with my dog To train/use for hunting To train/use for agility To train/use for a therapy dog To train/use as an assistance dog for the disabled To use as a guard dog For a jogging/hiking partner To interact with lots of friends and family As a gift for a friend or family member As a companion for my dog(s) As a companion for my cat(s) As a companion for myself As a companion for my child/children Please check all that apply: My adopted dog will... * Be kept outside most of the time Be kept indoors most of the time Be left outside during the work day and while we are away Be kept inside while we are away Be crated when we are not home Have free reign of the house when we are not home Be taken to formal obedience classes Be trained by me/us Take frequent car rides with us Be kept on a lead/cable in the yard Be mostly interacting with adults Be interacting frequently with children under 8 years old Be interacting frequently with older children Must be housebroken prior to adoption Will be walked occasionally Be trained by us without the advice of a trainer Have private session with a trainer as needed Be attending agility classes Be walked daily Be boarded when we go on vacation Stay with family when we go on vacation Be given away to someone else if we feel the dog is not a good match for us Be turned into a shelter if we cannot keep the dog Be going camping with us Be going on boat trips with us Do you have any additional comments, questions or concerns? Anything else you would like us to know in order to help match you with a dog? Please provide the name, phone number, address and relationship of 3 references * I agree that I have answered all questions truthfully and failure to release pertinent information could affect the decision on this application and may be cause for complete dismissal * I agree Applicants Signature * Today's Date * Where did you hear about this dog? Facebook Instagram Petfinder Wagtopia Adoptapet Bosleys Flyer Word of Mouth Other Thank you for your Adoption application. We will review your information and be in touch shortly!
