Application Form

APPLICATION FORM

Primary Applicant (must be 21 years of age or older)

First Name *

Last Name *

Phone *

Email *

Occupation *

Address *

City *

State *

Zip *

Household Members - People

How many other adults are in the home? *

What are their relationships to the primary applicant? *

How many children are in the home? *

What are the ages of the children? *

Does anyone in the house have allergies or asthma? *

If so, please explain *

Are all household members in agreement about adopting a dog? *

If not, please explain *

Who will be the primary caregiver for the dog (feeding, exercising, training, etc)? *

Have you or anyone in your household been convicted of animal cruelty, neglect or abandonment? *

Household Members - Pets

Do you currently have a dog? *

Dog name(s), breed(s), gender, and approximate age(s)? *

Do you currently have other pets? *

If so, what types of pets? *

Your veterinarian name and contact number *

House

Type of residence *

How long have you lived there? *

Do you plan to move in the near future? *

if you plan to move, what will you do with your pets? *

Do you own or rent? *

Name and phone number of your landlord *

Do you have a completely fenced-in yard (all sides)? *

Please indicate the type and height of fence *

Have any of your pets ever escaped from your home our yard? *

If so, please describe the circumstances *

Schedule

Are any adults home during the day? *

What is the typical works schedule of adults in the home? *

On average, how many hours will the dog be alone during the day? *

Where will the dog sleep at night? *

Training

Are you prepared to make a lifetime commitment to this dog? *

Are you willing to housetrain your new dog? *

How do you plan on socializing your new dog? *

How do you plan to give your dog enough exercise? *

Are you planning on taking your new dog to obedience or training classes? *

If you find it difficult to train the dog yourself, what will you do? *

Under what circumstances would you relinquish your new dog? *

Are you prepared to give your new dog daily care, companionship, and exercise, regardless of your schedule and other commitments? *

Cost

What is your estimate of the annual cost to care for a dog? *

Are you prepared to pay expenses for your new dog's care which includes food, supplies, veterinary care, licensing, etc? *

Experience

Please describe your past experience with dogs *

Are you aware of the dangers of leaving your dog outside in an enclosure or enclosed area when you are not home (as they could dig under or climb over a fence, become a nuisance barker to neighbors, or be stolen)? *

Are you aware of the 3-3-3 timeline (located on the Adopt section of our website) when a dog is adjusting to a new home and family? *

Are you aware that the 3-3-3 timeline is an estimate as each dog may take more or less time to adjust? And, that progress is not linear and that continued patience and understanding may be required during the adjustment period, especially for dogs with traumatic pasts? *

Rescues

How did you hear about us? *

Have you adopted from, or are you working with other rescues or shelters? *

Preferences

Please explain the characteristics of the dog you believe would be a good match for you and your family *

Size *

Breed(s) *

Age *

Gender *

What is your timeline for adopting? *

Are there any dogs on our website that you believe might be a good match for you? *

Certification

I certify that I am at least 21 years of age and that the information I have given is true. I understand that the rescue reserves the right to deny my application for any reason. I further authorize the investigation of all statements in this application. *

Signature *

Date *

Review & Submit

Submit your responses to this form.