Adopt a Dog

Please tell us about yourself
First Name *
Last Name*
Street Address*
Zip Code*
Home/Cell Phone*
Work Phone
Other Phone
Email Address
Please tell us about your co-applicant (spouse or significant other), if applicable
First Name
Last Name
Select type of animal Animal(s) of Interest
Dog    Cat   
What is the name of the animal(s) you are interested in?
List any general questions you have about this pet
May a representative from the rescue group visit your home by appointment? Yes    No   
Please check any of the following reasons for adopting this pet Family Pet 
Child's Pet 
Hunting Dog 
Guard Dog for Business 
Companion for Other Pet 
Other reasons for adopting
Please tell us about your home
Please indicate where you live Apartment 
Mobile Home 
Do you Rent    Own Home   
If you rent, what is the landlord/complex phone number?
How much is the pet deposit?
How many times have you moved in the past 5 years?
Do you foresee any major changes in your life in the next 15 years Yes    No   
If yes, please explain
Do you have a fully fenced yard? Yes    No   
If yes, please describe the type of fence and height
How many adults are in your household?
Does anyone in the household smoke? Yes    No   
Will this pet be a surprise for any family members? Yes    No   
If yes, for whom?
Do any family members have allergies? Yes    No   
Do children live in the house? Yes    No   
If yes, what are their gender/age?
Please tell us about your current pets and pet experience
Number, type and age of pets currently in household
Do any of your current pets or did any of your past pets live primarily outdoors? Yes    No   
If yes, please describe outside pets
Were all your previous pets spayed/neutered? Yes    No   
Are all of your current pets spayed/neutered? Yes    No   
Do you know what heartworm disease is and how to prevent it? Yes    No   
Do/did you use heartworm prevention? Yes    No   
What brand of heartworm prevention do/did you use and how often?
How do you plan to prevent fleas and ticks?
If you are applying for a cat, do you plan to declaw your new cat/kitten? Yes    No   
Have you always kept an ID tag with your phone number on your pet(s)? Yes    No   
Please describe what happened to each of your past pets (put to sleep, run over, died of old age, sold, given away, ran away, etc.)
What is your Veterinarian's name and phone number?
How many hours will your pet be home alone on a typical day?
Where does your current pet stay when home alone during the day?
Where will your new pet stay when home alone during the day?
Where do your current pets sleep at night?
Where will the new pet sleep at night?
What % of time will the pet spend indoors?
Do you have a pet door? Yes    No   
Under what circumstances do you think it is safe to leave a dog/cat outside alone or unsupervised in an unfenced area?
What circumstances, in your mind, justify giving a pet up? Moving 
New baby 
Not getting along with other pets 
Getting out of fence  
Behavior problems 
Lost interest 
If it gets too big 
Too time consuming 
Housebreaking problems 
Medical problems 
Aggressive behavior 
Other reasons for giving up pet
Have you ever given a pet up or had a pet and it didn't work out? Yes    No   
If you have given up a pet, please explain the circumstances and what happened to him/her
Have you ever looked at or applied for a pet with another shelter or rescue group? Yes    No   
Did you adopt? Yes    No   
If so, how long ago?
Which shelter/rescue group?
If you date or marry someone who does not like or want your pets, what would you do?
What type of food will you feed your pet(s)? (Brand Name)
Has a dog, puppy, cat or kitten died on your premises in the last 6 months? Yes    No   
Please list the names, addresses and phone numbers of 2 personal references
Verification Statement By checking here, I am attesting to the truthfulness of my answers.
Falsification of any of the above information will be grounds for disallowing the adoption of a rescue dog/cat and possible removal of said dog/cat from my home. Applicant must be 21 years of age or older. All shelters and rescue groups reserve the right to refuse any applicant.