Dog Adoption Application

Today's Date *

Dog's name: *

Applicant's First Name *

Applicant's Last Name *

Email Address *

Street Address (incl apt # if applicable) *

City *

State *

Zip Code *

Contact Number *

I certify that I am at least 18 years of age. *

*

We apologize, but we are unable to assist you with an adoption at this time due to the fact that you are under 18 years of age. Please check here to note that you agree.

How did you hear about us? *

Current Occupation/Employer *

Weekly Hours Worked *

Do ALL adults and other members in your household agree to this adoption? *

Names and Ages of Household Members (including yourself)? *

Please select one of the following *

Do you currently have pets? *

List your other pets, including name, age, sex, and whether they are neutered/spayed

What happened to the animal?

Do you have a current vet or low cost clinic where you take your dog for vaccinations? *

What is the name and address of your current veterinarian? *

What is your Vet's phone number? *

We ask that you provide us with a personal reference so that we can get some feedback about you as an individual. May we contact your personal reference? *

Please list the name and relationship of a reference we may contact. Please let them know we will be calling. *

Reference Phone number *

How do you know your reference? *

How long have you resided in your current location? *

What type of residence do you live in? *

Do you Rent or Own? *

Do you live in an HOA? *

*

If you live in an HOA, you should be aware that some HOAs do not allow certain breeds of dogs. Please, always be sure you check the rules of your HOA before applying to adopt a dog to ensure that the specific breed is allowed. Please check this box to show you understand.

If renting, are animals allowed on premise? *

Landlord's Name: *

Landlord's Phone number: *

Are you moving soon? *

If you are moving soon, what is the plan for your new pet? *

If you are planning to move, where are you moving to? *

Do you have a fence? *

Please describe your fence (height and type), as well as approximate yard space. *

I am looking to adopt for the following reason(s): *

Will the adopted dog live primarily inside or outside? *

If outside, what type of shelter will it have? *

Have you ever applied or adopted from another group within the last 5 years? *

Have you ever been declined for adoption ? *

If yes, what was the reason? *

Will the dog ever be left alone? *

How many hours (daily) will your dog be left alone? *

When your dog is left alone, where will he/she be left? *

How will your new dog get exercise? *

What is your general philosophy on vet care? *

Will you keep your dog on heartworm preventative? *

If no, why? *

Please list any circumstances you would have to give up your adopted pet. *

In the event you cannot keep your dog, for any reason, do you agree to contact Shelter2Rescue? *

Shelter2Rescue Coalition and the representatives of the rescue reserve the right to call and verify care of the adopted pet with the veterinarian. Please check to signify you understand this. *

I hereby agree to hold Shelter2Rescue Coalition, Inc and it's representatives harmless against any and all claims, damages, cost, expenses, or other items pertaining to dog that is being adopted, or anything resulting from or caused by the adopted dog. *

Full name (typed name will be accepted as signature) *