Application for Adoption
Please list the names and ages of any other adults are in your household beside yourself (leave blank if none).
Please list the names and ages of any children living in your household (leave blank if none).
If you currently do not have children, do you plan on having any in the next 10 years? Yes No Not Sure
Does anyone in the household have allergies to animals? Yes No
Is anyone a smoker? Yes No
What type of environment is your home located in? City Suburbs Rural
Is your yard fenced? Yes No Partly
Is there a chance you might move in the next 10 years? Yes No Not sure
If so, are you willing to restrict your choice of housing to places where a dog/cat is allowed? Yes No Not sure
Who will be responsible for this pet's care? Myself Spouse/co-applicant Child or children
What traits are you looking for in a pet (check all that apply) Male Female Young Old Companion Companion for another pet Special Needs Gift Other
Where will the animal be kept? Inside Only Outside Only Inside and Outside
Where will the animal sleep at night? Inside Outside Depends on the situation
How much time will the animal spend alone during the day?
Where will the animal be kept when you are not home?
What behavior would you not be able to tolerate? Aggression towards people Aggression towards other animals Marking/Housetraining issues Destructiveness Submissive Peeing Barking Rough Play Other
Do you understand that the dog will take time to adjust to its new surroundings and that new behavioral issues might arise during the adjustment period? Yes No
Are you willing to work with the dog to correct these issues? Yes No Not sure
Under what circumstances might you want to return the animal? (Examples: Marriage, new baby, divorce, behavior issues, financial stress, job change etc.):
Please list animals presently in your household. Please indicate name, species, sex, where the animal lives (in or outdoors).
Are your current cats/dogs on heartworm and/or flea preventative? Yes, both Heartworm only Flea/tick only Neither
Are your current cats/dogs up-to-date on all shots? Yes No
Are your current cats/dogs spayed/neutered? Yes No
Please list animals owned previously in the last 10 years. indicate name, species, sex, where the animal lived (in or outdoors), and what happened to the animal.
What do you like least about dog/cat ownership?
Please list the names and telephone numbers of 3 references (at least 2 not related to you):
Have you applied with any other rescue? Yes No
Please use this space if there is anything else you would like us to know in considering your application.
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