BCHA Dog Application

Applicant Information
First Name
Last Name
Phone Number
Alternate Phone Number
Email Address
Date of Birth
Employer Name
Occupation / Job Title
How long have you worked there?
How would you prefer to be contacted?	Text Email Phone
What is the best time to contact you?

Co-Applicant (Spouse/Partner) Information
First Name
Last Name
Phone Number
Email
Date of Birth
Employer
Occupation / Job Title
How long have they worked there?

Household Information
Street Address
City
State
Zip Code
Including yourself, how many adults (over 18) live in your household?
How many children (under 18) live in your house?
Please list the names, relationship and ages of everyone who lives in your home.
What is your household's general noise and activity level?
Please select your current residence type.
If you answered "other" above, please explain here:
How long have you lived at this address?
Do you own or rent your home?
If you rent, does your landlord and lease allow pets?
If you rent, please provide your landlord's name and contact information.
Do you have a fenced in yard?
If yes, how tall is your fence?

Animal Being Applied For
Name of dog you are interested in adopting
Enter name of dog (if not in drop down above)
Is this pet for you or someone else?
Please describe the dog you are looking for.
Why are you considering adopting a dog?
How did you find out about us?
Have you ever adopted a pet from BCHA?	Yes No
If yes, which animal and when?

Current Pet Information
Are there any pets currently in the household?	Yes No
If yes, how many?
Please list name, species, and age for all animals. (Include breed for dogs.)
Veterinarian's Name
Veterinarian's Phone Number
Are all of your pets spayed/neutered/fixed?	Yes No N/A
If no, please explain:
Are your pets current on their vaccinations?	Yes No N/A
If no, please explain:
Have you owned any pets in the last 5-10 years that are no longer in the home?	Yes No
If yes, what happened to them?
Have you ever surrendered an animal to a shelter or rescue?	Yes No
If yes, please explain:
Have you ever had a pet euthanized?	Yes No
If yes, please explain:

Applicant Questions
Is everyone in your household aware that you're planning to adopt a dog?
Check one:	Yes No N/A
Who will be responsible for care for this dog?
Caregiver(s):
What is your plan for training this dog?
Training Plan:
Does anyone in your household have allergies to dogs?
Check one:	Yes No Possibly N/A
Are you financially prepared to care for your new dog, including all food, supplies, and vet bills?
Check one:	Yes No
Where will this dog be kept?
Check one:	Indoors Outdoors Both
Will you keep the dog up-to-date on vaccinations?
Check one:	Yes No
If no, please explain:
What arrangements will you make for the care of your pets in case of an emergency?
Answer:
What would you do with your animal if you had to move?
Answer:
Are you willing to take responsibility for this animal for the next 10-20 years?
Check one:	Yes No
If no, please explain:
For what reason(s) would you consider returning/giving up the animal?
Answer:

Disclaimers & Signature
I hereby grant BCHA permission to confirm any information provided on this application with any appropriate third-party source, including landlords, veterinarians, etc. The information obtained will remain confidential and will be used by BCHA only for the purposes of evaluating the adoption application.
*	I Agree.
I understand that BCHA will consider the best interest of the animal when selecting an adoption placement. This means that BCHA may suggest a different animal if my first choice is not a good fit.
*	I Agree
I understand that BCHA reserves the right to deny any adoption application at its own discretion.
*	I Agree.
I certify that my answers are true and complete to the best of my knowledge. I understand that any false information, omissions or misrepresentations may result in the rejection of this application.
Sign Here: *

BCHA Dog Application

Applicant Information

Co-Applicant (Spouse/Partner) Information

Household Information

Animal Being Applied For

Current Pet Information

Applicant Questions

Disclaimers & Signature