ADOPTION APPLICATION

When completed please print out and bring with you to adoptions.

The following information is requested so that we can assist you in the selection of a new dog.  
Request a copy of the form to fill out, by clicking here and requesting one.

In order to be considered as an adopter you must:

•  Be 21 years of age or older.
•  Have identification showing your present address.
•  Have the knowledge and consent of your landlord.
•  Be able and willing to spend the time and money necessary to provide training,
•  Medical treatment and proper care for a pet.

Completion of this application does not guarantee adoption.

What dog(s) are you interested in? Please specify the name(s) below and provide a reason.

Name of Dog(s):      Reason you would like to adopt:

Contact Information:

Name of Applicant:  Age:    Date:

Spouse/Partner:    

Street Address: 

City:  State:  Zip:

Phone:     Cell:     E-mail:

What pet(on our website) are you interested in?    

What brand(s) of food do you feed your pets?


Pet History:
Please fill out for each pet's past:

Pet 1
Name/Breed:  Sterilized? Yes/No    Weight(lbs)?    
How long owned?    What happened?               

Pet 2
Name/Breed  Sterilized? Yes/No   Weight(lbs)?    
How long owned?    What happened?               

Pet 3
Name/Breed  Sterilized? Yes/No    Weight(lbs)?  
 How long owned?    What happened?               

Pet 4
Name/Breed  Sterilized? Yes/No    Weight(lbs)?    
How long owned?   What happened?               

Pet 5
Name/Breed  Sterilized? Yes/No   Weight(lbs)?    
How long owned?    What happened?               
                

Personal Information

Occupation: Work Home or Other:    Hours/Days:  

Spouse/Partner
Occupation: Work Home or Other:    Hours/Days:

How many children in home?      Names/Ages:

Any visiting children, neighbors, relatives?  

Others living in household? 

Family
Would this be your first dog? 

What kind of pets have you had in the past?

What current pets do you have?  Dogs  Cats 

Are they dog socialized?  How?  

Have they been spayed or neutered? Yes/No/Don't Know  

Are they current on vaccinations? Yes/No/Don't Know  

Have you ever turned your dog in to a shelter? Yes/No   If yes, please explain:

Have you had a pet euthanized? Yes/No    If yes, please explain:

Have you ever introduced a  new dog in your house? 

Was your last dog obedience trained? Yes/No/Doesn't Apply  

Why do you want this dog?    Companion/Companion for other pet/House pet/Watchdog/Guard dog/Hunting/
Personal protection are just a few examples, whats your reason?

Does any member of your household have an allergy to dogs?

Is someone home during the day?  Who?

How many hours each day will the dog be without human companionship? 
Explain: 

Home
Which do you live in?   House/Apartment/Condo/ Mobile Home/Other: 
If other, explain:

Do you own or rent your home? 

If you rent, may we contact the owner to obtain permission for this animal to live in your home? 

Owner’s name and phone number: 

Do you have a completely fenced yard? Yes/No   
If yes, what kind of fence?
Height: Is there a gate? Yes/No:
Under you side gates is there cement or dirt under your gate?  

Do you have a doggie door? 

Are there times when the dog will be tied up? Yes/No , If yes, when?

What outside shelter will you provide if your dog is to sleep outside?

Will the dog spend any time in the garage? Yes/No  If yes, when and why:  

Do you have a pool? Yes/No   If yes, is there a fence around the pool? Yes/No  

Do you have a Gardener?  Yes/No    

Are you willing to change your gardener’s to a day that  you are home?     Yes/No  

Does you housekeeper/other open a yard gate to take the trash out?   Yes/No  

Health
Will you keep the dog up-to-date on vaccinations? 

Who is your veterinarian?  City or town:

Veterinarian’s phone number

Permission to check vet records under you name?  

What type of flea control will you use? 

How will you care for your dog’s teeth? 

Do you walk your dogs?   Where?  

Where will this dog be kept during the day? 

Where will the dog sleep? 

If you drive a pickup truck, would you allow the dog to ride in the back? Yes/No

If you go away for a few days, or on a vacation, who will take care of the dog? 

If you move, will you take the dog with you? Yes/No   Explain

How much are you willing to spend on medical bills for your dog?  Respond Yes/No    Up to $100.00 
up to $500.00    up to $1000.00  up to $5000.00        whatever it takes.


Discipline
What method will you use to housebreak your dog?  

When will the dog be off-leash? 

What discipline will you use if your dogs chews your favorite shoes? 

Will your dog wear a choke chain?       When?        Why?

Which of the following discipline’s will you use if your dog just won’t listen and is really naughty?  Respond Yes/No
Stern Voice   Spank Fanny  Time-out   Other: 

Do you think it’s necessary for your dog to wear an ID tag? Yes/No  

Have you ever been denied to adopt a dog or cat from this rescue before? Yes/No  
If yes, reason? 

Are you willing to have a representative of Kinder4Rescue aka Chihuahua Connection come to see where the dog will be living


What provisions will you make for the dog should you become unable to care for it?