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Hear the Cry, Rescue Don't Buy!
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Home
Services
Prices
Schedule
Dental Information
Location
Donate
Patient Forms
Adoptions
Resources
Adoption Application
You are here:
Home
Adoption Application
Adoption Application
Name or Type of dog that you're interested in adopting
*
Personal Information
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Email
*
Main Phone #
Alternate Phone #
Occupation
*
Spouse/Partner Occupation
Your Age
*
How many adults live in your home?
*
Who will be the primary caregiver?
*
How many children live in your home?
*
What are their ages?
Do you or anyone else in your household have pet allergies?
*
Yes
No
Veterinarian's name and number:
*
Do we have permission to check past vet records?
Your Home
Which do you live in?
*
House
Apartment
Townhouse
Condo
Mobile home
Do you own or rent?
*
Own
Rent
If you rent, do you have your landlord's permission to own a dog?
Yes
No
If yes, we would also want to contact the owner to get confirmation.
Are there any breed or weight restrictions?
Yes
No
Please explain the breed or weight restrictions at your rental property
Do you have a yard?
*
Yes
No
Is the yard totally enclosed?
Yes
No
What is the lowest height of your fence?
Is the fence/gate kept locked?
Yes
No
Have you recently checked the entire perimeter of the fence to ensure that a dog cannot escape?
Yes
No
LOOK FOR SOFT DIRT TO DIG UNDER, BARS SPACED TOO FAR APART, etc
Do you have a pool?
*
Yes
No
Is the pool fenced?
Yes
No
Do you have a doggie door?
*
Yes
No
Can you ensure that your gardener, housekeeper, etc will not let the dog out of the yard?
*
Yes
No
Future Dog and Pet History
Do you have any other pets?
*
Yes
No
Please list their breed and age
Do they live inside or outside?
Inside
Outside
Are they up to date on their vaccinations?
Yes
No
Are your pets neutered/spayed?
Yes
No
Are they dog socialized?
Have you ever introduced a new dog into your home? If yes, how did it go?
Do you walk your dogs? If yes, then where?
If you were to see a Coyote on your walk what would you do?
*
Which of the following are true?
*
I have never seen a coyote, I'm not worried,
Coyotes come out during the day
Coyotes can jump over an 8ft. fence
Coyotes will attack dogs even on leashes
Coyotes are not afraid of humans
All of the above
Check all that apply
If you drive a pick-up truck, would you allow your dog to ride in the back?
*
Yes
No
Have you ever owned a pet before that you no longer have?
*
Yes
No
Please list them all and explain what happened to each one
*
Eg. Passed away, given away to family, taken to a shelter, ran away, etc.
Was your last dog obedience trained?
Yes
No
Have you ever turned your pet into a shelter?
*
Yes
No
If yes, please explain.
Please enter a number from
0
to
24
.
Why do you want to adopt this dog?
*
Companion for you
Companion for children
Playmate for other pets
Guard dog/protection
Therapy dog
Gift
Other (please explain)
Check all that apply
How many hours will the dog be left alone on a typical weekday?
*
Please enter a number from
0
to
24
.
Where will the dog be kept during the day?
*
Indoors (loose)
Indoors (in one room)
Laundry room
Crated
Balcony
Tied up
Yard
Enclosed patio
Dog-run
Garage
Check all that apply
Will any place be off-limits for the dog when you are home? (i.e.- furniture, bedrooms, etc)
*
Would this dog be left alone in the yard at any time? If yes, please explain.
*
Where will the dog sleep at night? (please be specific - eg. garage, kitchen, etc)
*
Brand and Type of food you will feed the dog?
*
Which pet store will you purchase the food from?
What type of flea control will you use?
How will you care for your dog's teeth?
*
How much are you willing to spend on medical bills for your dog?
*
up to $100
up to $500
up to $1000
up to $5000
whatever it takes
Check all that apply
If you did not answer "whatever it takes" - what would you do if the vet bills go over the amount you chose?
Under what circumstances would you consider giving up this dog?
*
Destructive chewing
Barking
Not housebroken
Biting
Too shy
Shedding
Separation anxiety
Medical problems
Not obedient enough
Grows too big
Too hyper
Pets don’t get along
Working too many hours
Moving
New baby
Divorce
Allergies
Financial problems
Personal health problems
None of the above (I would not give up this dog)
Check all that apply
If you move will you take the dog with you? If no, please explain.
*
What will you do if you move somewhere where dogs are not welcome?
*
For what reason would you euthanize a dog?
*
Do you think it's necessary for your dog to wear an ID tag?
*
What provisions will you make for the dog if you should become unable to care for it?
*
Who will take care of the dog when you travel?
*
What methods will you use to train this dog?
*
Praise
Verbal commands
Clicker training
Hit with newspaper
Spanking
Shock collar
Hire a trainer
Group classes
Check all that apply
What method will you use to potty train?
*
When would the dog be off-leash outdoors?
*
Will you use a choke chain? If yes, then when and why?
*
May we conduct a home check prior to finalizing the adoption?
*
Yes
No
Are you ABSOLUTELY SURE that you are ready to make this LONG TERM COMMITMENT?
*
Yes
No
How did you hear about us?
Name
This field is for validation purposes and should be left unchanged.
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