NAME OF THE PET(S) YOU'RE APPLYING TO ADOPT:
HOW/WHERE DID YOU HEAR ABOUT THE PET?
HOW LONG HAVE YOU BEEN LOOKING FOR A PET?
WHY HAVE YOU CHOSEN THIS TIME YOUR LIFE TO GET A NEW PET?
WHY HAVE YOU CHOSEN THIS PET IN PARTICULAR?
- - PERSONAL INFORMATION - - Please Note: If you are approved to adopt, this information will be used to register your new pet's microchip so provide as much contact info as available and ensure that it is completely correct!
FIRST NAME:
LAST NAME:
EMAIL ADDRESS:
DRIVER'S LICENSE NUMBER:
DATE OF BIRTH:
STREET ADDRESS:
CITY:
STATE:
CA
NV
OR
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AK
AL
AR
AZ
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
ZIP CODE:
HOME PHONE:
WORK PHONE:
CELL PHONE:
IN THE EVENT THAT YOU CANNOT BE REACHED AT THE NUMBERS ABOVE, PLEASE PROVIDE THE FULL NAME AND TELEPHONE NUMBER(S) OF A NEARBY FRIEND OR FAMILY MEMBER WHO DOES NOT LIVE WITH YOU:
TYPE OF HOUSING YOU LIVE IN:
IF YOU RENT YOUR LIVING SPACE OR LIVE WITH YOUR PARENTS, PLEASE PROVIDE YOUR PARENT'S OR LANDLORD'S NAME AND TELEPHONE NUMBER:
ARE PETS ALLOWED? IS A PET DEPOSIT REQUIRED? HAVE YOU PAID IT?
HOW LONG HAVE YOU LIVED AT YOUR PRESENT ADDRESS?
ARE YOU PLANNING TO MOVE IN THE NEXT 12 MONTHS?
IF YOU MOVE, WHAT WILL YOU DO WITH YOUR PETS?
HOW MANY ADULTS RESIDE IN YOUR HOUSEHOLD? WHAT IS THEIR RELATION TO YOU?
ARE THERE CHILDREN IN THE HOME? IF SO, WHAT ARE THEIR AGES?
WHO WILL BE THE PRIMARY (One Person) CARETAKER OF THE PET?
IS THERE ANYONE IN THE HOUSEHOLD WHO DOES NOT WANT THIS PET?
IS ANYONE IN THE HOUSEHOLD ALLERGIC TO PETS? HOW WILL YOU HANDLE THIS?
DO YOU HAVE GARDENERS, METER-READERS OR REPAIRMEN WHO NEED ACCESS TO YOUR HOUSE OR YARD WHILE YOU ARE NOT HOME? IF SO, HOW WILL YOU ENSURE THEY DON'T LET THE PET OUT?
- - CURRENT PETS/PET HISTORY - -
PLEASE PROVIDE YOUR REGULAR VETERINARIAN'S NAME, OFFICE NAME, AND TELEPHONE NUMBER:
PLEASE LIST ALL CURRENTLY OWNED PETS, INCLUDING SMALL CAGED AND BARNYARD ANIMALS. INCLUDE THEIR SPECIES, BREED, AGE, GENDER, AND HOW LONG YOU'VE HAD EACH ONE. TELL US A BIT ABOUT EACH PET IN YOUR HOME.
DO YOU USE ANY FLEA PREVENTATIVE FOR YOUR CURRENT PETS? IF SO, WHICH BRAND AND HOW OFTEN?
DO YOU USE ANY HEARTWORM PREVENTATIVE FOR YOUR CURRENT PETS? IF SO, WHICH BRAND AND HOW OFTEN?
HAVE YOUR PETS BEEN SEEN BY YOUR REGULAR VETERINARIAN IN THE PAST 12 MONTHS? ARE THEY UP TO DATE ON VACCINES?
ARE ANY OF YOUR PETS NOT ALLOWED OUTDOORS? IF NO, WHY?
ARE ANY OF YOUR PETS NOT ALLOWED INDOORS? IF NO, WHY?
WHICH OF YOUR PETS ARE SPAYED/NEUTERED?
WHAT BRAND OF FOOD DO YOU FEED YOUR PETS? WHAT BRAND DO YOU PLAN TO FEED TO YOUR ADOPTED PET?
ARE YOU INTERESTED TO LEARN ABOUT HIGHER QUALITY BRANDS OF FOOD? WOULD YOU BE WILLING TO SWITCH YOUR PETS TO A HIGHER QUALITY FOOD IF ONE WAS RECOMMENDED?
PLEASE LIST ALL ANIMALS, OTHER THAN THOSE LISTED ABOVE, THAT YOU HAVE OWNED IN THE LAST FIVE YEARS AND HOW LONG YOU OWNED EACH ONE.
WERE ANY OF THOSE PETS INDOOR-ONLY ANIMALS? WERE ANY OF THEM NOT ALLOWED INDOORS?
WHICH OF THOSE PETS WERE SPAYED/NEUTERED?
WHAT HAPPENED TO THE PETS THAT ARE NO LONGER WITH YOU?
HAVE YOU EVER ALLOWED ANY OF YOUR PETS TO HAVE OFFSPRING? IF SO, WHAT HAPPENED TO THE OFFSPRING?
HAVE YOU EVER HAD TO EUTHANIZE A PET? IF SO, TELL US ABOUT THE CIRCUMSTANCES.
HAVE YOU EVER BROUGHT AN ANIMAL TO A SHELTER ("POUND", SPCA, HUMANE SOCIETY, ANIMAL RESCUE, ETC."), GIVEN AWAY, OR SOLD AN ANIMALS? IF SO, PLEASE TELL US ABOUT THE CIRCUMSTANCES.
- - DOG SELECTION - -
WHAT IS YOUR MAIN REASON FOR WANTING A DOG?
I ALSO WANT IT TO BE (CHECK ALL THAT APPLY):
IF YOU SELECTED OTHER, PLEASE ELABORATE:
IF THIS DOG IS A GIFT, WHO IS IT FOR?
TEMPERAMENT PREFERRED (CHECK ALL THAT APPLY):
IF YOU SELECTED OTHER, PLEASE ELABORATE:
PLEASE PUT THE FOLLOWING IN ORDER OF IMPORTANCE TO YOU:
A) Play with my other pet(s)
I WOULD LIKE MY NEW DOG TO GET ALONG WITH:
IF YOU SELECTED OTHER, PLEASE ELABORATE:
- - PET CARE INFORMATION - -
HOW MANY HOURS A DAY WILL THE DOG BE LEFT UNATTENDED?
HOW WILL YOU EXERCISE THE DOG?
WHAT PERCENTAGE OF TIME PER DAY WILL THE DOG BE: A. IN THE HOUSE B. IN THE YARD C. IN A CRATE
WHERE WILL THE DOG BE KEPT WHILE YOU AREN'T HOME (EX. RUNNING ERRANDS)? (BE SPECIFIC)
WHERE WILL THE DOG BE KEPT WHILE YOU ARE HOME? (BE SPECIFIC)
WHERE WILL THE DOG BE KEPT AT NIGHT?
WHAT ROOMS, IF ANY, ARE OFF LIMITS TO THE DOG?
WILL THE PET BE ALLOWED ON YOUR FURNITURE? IF NO, HOW DO YOU PLAN TO TRAIN YOUR DOG THIS BEHAVIOR?
HAVE YOU EVER HOUSETRAINED A DOG BEFORE? WHAT METHODS DO YOU OR WILL YOU USE?
HOW WILL YOU KEEP THE DOG CONFINED TO YOUR PROPERTY?
IF OTHER, PLEASE ELABORATE:
WHAT WILL YOU DO TO PREVENT YOUR PET FROM BECOMING LOST?(ID & Microchip only assist with identifying the pet after it has been lost, then found. They do not prevent the pet from becoming lost.)
IF YOUR DOG IS LOST, WHAT WOULD YOU DO TO FIND IT?
DOGS OFTEN DIG, BARK, JUMP FENCES, AND CHEW ON INAPPROPRIATE THINGS. WHAT WOULD YOU DO IF THIS DOG DID THOSE THINGS?
PLEASE SELECT ALL THAT APPLY TO YOUR HOME:
- - COMMITMENT - -
HOW LONG DO YOU PLAN ON KEEPING THIS DOG?
WHAT CIRCUMSTANCES WOULD CAUSE YOU TO REHOME/RETURN THE ADOPTED PET? (CHECK ALL THAT APPLY)
IF OTHER, PLEASE ELABORATE:
IF YOUR PRESENT RELATIONSHIP WERE TO CHANGE, WITH WHOM WOULD THE DOG(S) REMAIN?
IF YOU WERE TO PASS AWAY OR BECOME UNABLE TO CARE FOR YOUR ANIMALS, HAVE YOU MADE ARRANGEMENTS FOR THEM? IF YES, WHAT ARE THEY?
A PET MAY LIVE TO BE 12 TO 20 YEARS OLD. ARE YOU WILLING TO MAKE A LIFETIME COMMITMENT TO THE CARE OF THIS PET?
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Yes
Maybe
No
DO YOU AGREE TO ALLOW A RESCUE VOLUNTEERS TO MAKE AN ASSESSMENT OF YOUR HOME, YARD, AND FAMILY TO DETERMINE IF THEY ARE SUITABLE FOR THIS PET?
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Yes
Maybe
No
STANDARD MEDICAL CARE COSTS RANGE FROM $100 TO $200 PER YEAR. EMERGENCY CARE CAN COST HUNDREDS OR EVEN THOUSANDS OF DOLLARS. ARE YOU WILLING TO AND DO YOU HAVE THE FUNDS TO PROVIDE ROUTINE AND EMERGENCY VET CARE TO THIS PET FOR THE ENTIRETY OF HIS/HER LIFE?
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Yes
Maybe
No
RESCUED PETS ARE OFTEN NERVOUS/SCARED WHEN MOVING TO A NEW HOME ENVIRONMENT. IT MAY TAKE THEM A FEW HOURS TO A FEW WEEKS TO ADJUST TO THEIR NEW HOME ENVIRONMENT AND TO TRUST YOU. DO YOU AGREE TO GIVE THIS PET A MINIMUM OF TWO WEEKS TO FEEL COMFORTABLE?
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Yes
Maybe
No
PLEASE REMEMBER THAT THIS APPLICATION IS OUR ONLY GLIMPSE AT THE LIFE THAT YOU CAN OFFER TO ONE OF OUR RESCUED PETS. PLEASE BE AS SPECIFIC AND DETAILED AS POSSIBLE. IF THERE IS ANY OTHER INFORMATION YOU'D LIKE TO INCLUDE FOR OUR KNOWLEDGE, PLEASE DO SO HERE:
I CERTIFY THAT I AM OVER 21 YEARS OF AGE AND THAT THE ABOVE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT EAR MAY VISIT MY HOUSE TO ASSESS THE STATUS OF THE ADOPTED PET(S).
PLEASE BE SURE THAT AFTER YOU CLICK SUBMIT YOU LEAVE THE NEXT PAGE OPEN UNTIL THE STATUS BAR AT
THE TOP SHOWS THAT THE APPLICATION HAS BEEN FULLY SUBMITTED! THANK YOU!
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