-Saving Dogs 4 Paws at a Time Adoption Application-

Animal you are interested in adopting	Macy (Dog - 064-21) Maggie (Dog - 071-23) Mater (Dog - 059-23) Merlin (Dog - 069-23) Roscoe (243-17) (Dog - 226-18) Sprocket (Dog - 072-23) Tiny Tilly (Dog - 020-23)
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Best Phone Number *
Other Phone Number
Email Address *
age of applicant *
Is your pet listed under another owner at the vet than the one above? *
Have you applied anywhere else for a pet?	NoYes
If yes, where else have you applied for a pet?
Do you own other pets at the current time? *	NoYes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed? *	Yes No N/A
How many pets have you owned in the last 5-10 years? *
What happened to them?
Are your pets current on their vaccinations?	Yes no n/a
Have you ever relinquished, given away or re-homed a pet to a shelter, rescue, family or individual? *	Yes No
If yes, please explain?
Veterinarian's Name (List all Vets you have used in the past 5 years) *
Veterinarian's Address, City, State, and Zip Code
Veterinarian's Phone Number (All Vets for past 5 years) *
Have you ever had a pet euthanized?	NoYes
If yes, please explain:
Are you familiar with heartworm and heartworm prevention? *	Yes No Not sure
Please check the main reason you plan to adopt a pet:	Companion Family Pet Child's Pet Guard Dog Companion for another pet Other
Please explain:
Why do you wish to adopt and what makes this dog a good fit for your family? *
When your family encounters a life-changing event, such as moving, marriage, having a baby, death in the immediate family, what would you do? *
Do you own or rent your home?	Own Rent Someone else owns the Home Someone else rents the Home
If you rent, enter name, address and phone number of landlord.
Please select your current residence type.	House Apartment Condo Townhouse Mobile Home Other
If you answered "other" above, please explain here:
How long have you lived at this address?	Less than one month 1-2 months 3-6 months 6-9 months 9-12 months 1-2 years 3-5 years 6-10 years 10 + years
If less than 3 years, list all addresses for the past 3 years with dates.
If you rent, does your landlord and lease allow pets?	Yes No Unsure N/A
Including yourself, how many people live in your household?
Please list the ages & relationship of those who live in your home. *
Is everybody in your household aware of and OK with the fact that you wish to adopt a dog? *	Yes No N/A
Does anyone in your household have allergies to dogs/cats?	Yes No Possibly N/A
Employment Status *	Full-Time Part-Time Retired Work from Home Stay at Home Parent Student Unemployed Other
If you chose "other" above, please explain:
Current Employer/Occupation
On average, how many hours per day will your pet be left alone? *
Will this pet be predominantly living inside, outside, or both? *
Please provide a description of this pet's living conditions. *
Do you have a completely fenced-in yard? If so, what kind of fence? *	Wood Chain Link Electric Plastic Iron Other Other (I do not have a fenced yard)
If you answered "other" above, please explain:
If you do not have a fenced yard, how will you let the animal out?
Are there times when the animal will be tied/chained up? *
If yes, when will they be tied/chained up?
Where will the animal sleep? *	In bed with me In bed with my child In a dog / cat bed In a kennel / crate Wherever he or she likes Outside Other
If you answered "other" above, please explain:
How will you handle housebreaking?
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative? *
If no, please explain:
How will you provide exercise on a regular basis?	Yes No N/A
If you answered "other" above, please explain:
What arrangements will you make for the care of your pets in case of an emergency?	Leave with family/friend Boarding Pet Sitter Take with me/us Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation? *	Leave with family/friend Boarding Pet sitter Take with me/us Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up or re-homing the animal? What would you do with him/her? *
What would you do with your animal if you had to move?	Take him / her with me Give to family or friend Return to Rescue Other
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years? *	NoYes
If no, please explain:
I certify that I am 20 years of age and that all information provided on this form is true. I give permission to rescue to verify information as needed. I understand that a home check may be mandatory prior to adopting a pet. Any false statement will terminate potential adoption. If at any time I can no longer keep my adopted pet, I will contact Saving Dogs 4 Paws at a Time so arrangements can be made to bring the animal back into the rescue. I understand the sole purpose of this application is to find right placement and a lifetime, loving home for Saving Dogs 4 Paws at a Time dogs. The best interest of our dogs takes precedence over all other factors. I understand that this application does not guarantee that I will be approved to receive this or any dog from Saving Dogs 4 Paws at a Time. Answering "Yes" constitutes my signature on this application.	Yes No

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