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Adoption Application

Before clicking 'submit' please read carefully:
 
Answers will not be shared with any outside parties, unless you give us permission below.
 
Before submitting your application, please make sure you have answered all questions to the best of your ability.  Incomplete applications may be rejected or delayed.
 
But submitting this application, you represent that the information you have provided on this form is true to the best of your knowledge and belief. 
 
By pressing subit you also certify that you have never been convicted of animal cruelty, neglect, or abandonment by a court of law or other governmental authority.

Please make sure the application is complete and that you have entered your correct email address (including the @yahoo.com, @hotmail.com, etc.) before submitting this application.

Name
Address
City, State, and Zip
E-mail Address (mandatory to contact you)
Home Phone
Cell Phone
Work Phone
How long have you been at your current residence?
If less than a year, please state how long at your previous residence
Do you own or rent?
If you rent, do you have permission to own a dog?
Will you be able to provide us with a copy of your lease aggreement or a letter from your landlord that states you are allowed to own dogs?
Landlords Name:
Landlords Phone Number
What type of home do you own or rent?
How many adults are in the home? What genders?
How many children are in the home? What genders and ages?
Does everyone agree to adopting a dog?
Do you have a fenced yard?
If yes, what type of fence is it (i.e. chain link) and what is its height and size?
If no fence, how will you handle the dog's exercise and toilet duties?
Do you have a kennel run the dog will use?
If yes, what is it's size and height?
Are there regular visitors to your home (human or animal) with which your new dog must get along?
If yes, please describe
Do you own cats?
If yes, please state their name, age, gender, whether they are neutered or not, where you obtained him or her from, how long you have owned him or her, if he or she has had any medical problems, and his or her behavior
Do you own dogs?
If yes, please state their name, age, gender, whether they are neutered or not, where you obtained him or her, his or her breed, how long you have owned him or her, if he or she has had any medical problems, and his or her behavior
Do you own any other animals?
If yes, what kind?
Please tell us of all the dogs and cats your have owned in the past 10 years, their name, age, sex, whether they were neutered or not, breed/species, and what happened to them
What type of a dog are you looking to adopt (breed, behavior, age, etc.)
List all plans for this dog
Where will the dog spend most of its day?
Where will the dog sleep at night?
On average, how many hours a day will the dog be left alone?
When left alone, where will the dog be kept?
Do you understand that all dogs are neutered or spayed before going to their new home?Yes
No
Do you agree to license this dog and continue to do so with your county?Yes
No
Do you agree to provide proper medical care when needed?Yes
No
Do you agree to contact us if you can no longer keep this dog?Yes
No
Do you agree to a home visit?Yes
No
If no, why?
If you are not in our area, or if we do not have a dog that fits you and your lifestyle, can we send your application along to another rescue?Yes, you may share my information to other rescues
No, you may not share my information with other rescues
Is there anything more you would like to add?
Is there a dog you already would like to adopt?
If yes, what is the dog's name?
Why would you like to adopt this dog? Why do you think he or she would fit into your home and lifestyle?