| First
Name: |
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| Last
Name: |
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| Street
Address: |
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| City,
State Zip: |
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| Name
of the pet you are interested in: |
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| I
am looking to adopt a dog that lives mainly as a: |
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| How
soon will you be ready to adopt a new dog/puppy? |
|
| What
is your occupation and your daily work hours? |
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| Co-Adopters
Full Name: |
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| Co-Adopters
occupation and work hours: |
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| Home
Phone Number: |
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| Cell
Phone Number: |
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| Can
you be reached during the daytime? If so - at what
number: |
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| Email
Address: |
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| Please
list all members that live in this household and their ages: |
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| Please
tell us why you would like to adopt a new family member: |
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| Do
you Own or Rent? |
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| If
you rent - please provide your landlords name and phone number: |
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| Do
you have a fenced yard? |
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| If
NO, how do you plan to exercise and potty the dog/puppy? |
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| List
all current pets including breed, sex and age: |
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| Please
list the name, phone number and city of the veterinarian who has the most current records on your
pets |
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| Are
all your pets Spayed and/or neutered? |
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| If
No - why? |
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| Are
your pets current on their vaccinations? |
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| Do
you know what Heartworm is? |
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| Do
you believe dogs should be given monthly Heartworm pills? |
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| What
brand of Heartworm pills do you use? |
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| Please list any previous pets you have had in past 5 years and
explain what happened to them? |
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| Have you surrendered any animals to a local shelter?
If so, why? |
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| What breed or specific breed listed are you interested in? |
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| Why do you like this breed? |
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| Do ALL members of this household want to adopt this dog? |
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| Who will be primarily responsible for the pet? |
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| If you have owned a dog before, what brand of dog food/s have you used and were you happy with the food? |
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| How much time are you willing to give this dog to adjust and fit into your home? |
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| It may take several weeks to a few months for your new dog to adjust to its new home and family.
How will you handle this? |
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| How many hours per day on average will this dog be home alone? |
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| When the dog is left home alone, where will the dog stay? |
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| Where will this dog sleep at night when trained? |
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| In an average week, how many hours will the dog be left outside while no one is home? |
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| Do you have time, patience, love and physical ability to care for this dog? |
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| Did you know such dog foods as Science Diet, Iams and Purina have little to No nutritional value? |
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| Are you interested in knowing which dog foods, for the same price of the above foods ARE quality dog foods? |
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| What activities do you plan to do with your dog? |
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| Do you want this dog for: (list all that apply) ~ Family Pet ~ Hunting Dog ~ Guard Dog ~ Obedience Dog ~ Other (please explain) |
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| Are you prepared for chewing, digging, scratching, house training, and/or mischievous behavior? |
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| How will you reprimand your dog? |
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| How and where did you hear about this rescue and/or website? |
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| If the dog you are wanting to adopt is too young to be spay or neutered or a medical condition is delaying the spay or neuter of the dog you adopt are you willing to put down a $25.00 deposit in addition to the adoption fee indicated for the dog your interested in-that will be refunded to you if the dog has been spay or neutered be the time we indicate? |
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| Are you available for a home visit? |
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| Have you applied with any other Rescue or Shelter in the past 6 months? |
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| If YES, please list which one/s and if you have you been approved by, along with their contact information or if you are still waiting for an answer. |
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| Has this Rescue or Shelter conducted a home visit? |
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| Please list anything else you would like us to know: |
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NOTE: We no longer can take personal
checks. Payment Methods are: Cashiers Check, US Post Office Money Order, Cash or Credit Card through Paypal. (If using Paypal, we require payment 48 hours prior to adoption.)
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| I (type your name in box on right)
have read ALL of the above information and have answered each question completely and truthfully to the best of my ability. |
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By submitting this application, I, (type name in box on right again!)
AGREE to any and all terms listed on this application! |
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NOTE: We reserve the right to deny any application. We reserve the right to decline an application without releasing our reasons
why. |
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Sign full name in box on right! |
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