Adoption Application

Name of dog you are interested in (if known):
Your name:*   Age:
Address:*   City*   State*   Zip code*
Home Phone:   Cell Phone:

NOTE: If you do not provide a phone number, application will be discarded

Best time to call:
Work Phone:   May we call you at work: Yes    No   
Spouse/Partner's Name:   Phone:

Personal References who are familiar with you as a pet owner. Not more than one relative please. If your dog(s) require(d) grooming please include your groomer as a reference. If you have adopted a dog from another rescue use them as a reference.

Reference #1.

Name:     Phone:
E-mail:   Relationship:

Reference #2.

Name:     Phone:
E-mail:   Relationship:
Do you live in: House    Apartment    Condo    Mobile Home    Other    
Do you: Own    Rent   
If renting-Please give us landlord’s Name:
If there is a limit on the number of dogs you are allowed, please note the limit:
How long at this address:
If less than 1 year, how long at previous address?
Do you have a securely fenced yard: Yes    No   
Type & height of fence:
If no fence, how will you exercise the dog & let the dog relieve him/herself?:
How many adults in the household & their ages please list?
How many children, their ages & sex?
Have children been raised with dogs? Yes    No   
If no children, do you plan on having children someday? Yes    No   
Do all members of the household wish to adopt this dog? Yes    No   
Who will take care of the dog?
Are there regular visitors to your home (human & animal) with which your new dog must get along? Yes    No   
Please list other pets(type, breed, size, age, gender):
Vet's Name:
How many dogs have you owned in the past 5 years?
List each dog, giving breed and where the dog is now:
Where will the dog spend the day?
On an average, how many hours each day will the dog spent without human companionship?
Where will the dog sleep at night?
Who will care for your dog when you are on vacations or emergencies?
Have you ever adopted an animal from a rescue or shelter before? Yes    No   
If Yes-Which recue or shelter was it?
Have you ever released an animal to a rescue or shelter? Yes    No   
If Yes-Please explain?
What will happen to the dog if you move?
Do you agree and promise to contact the rescue you adopted the dog from if you can no longer keep this dog? Yes    No
Are you willing to let a rescue representative visit your home before adoption? Yes No   
Have you applied with another rescue organization? Yes    No   
How did you hear about us (Petfinder, Rescue Me, website, other)?
Signature:*   Date:*