Adoption Application

Name of the Adorable Dog are you interested in adopting, if known?

What type of Dog are you most interested in adopting (Breed/Sex/Age)

Full Name

Full Name

First Name*

Last Name*

Age

E-mail*

Address

Address

Street Address

Street Address Line 2

City

State/Province

Postal / Zip Code

Country

Phone Number Home

Phone Number Home

Area Code

Phone Number

Phone Number Cellular

Phone Number Cellular

Area Code

Phone Number

Driver's License #

State

Are you currently employed?

Other

Name of Employer

How much disposable monthly income (money left over after paying bills and necessities) do you have? Caring for a dog can be costly and requires a commitment.

Do you live in a

Are you able to care for an Adopted Dog now and in the future should the pet become ill or injured?

Do you

Own

Rent

Live with Parents

Other

Household Setting

Rural

City

Describe the Activity Level in your Home

Busy/Noisy

Moderate Comings/Goings

Quite with Occasional Guests

Please List all People Living in the Household (Include Name, Relationship, Gender and Age)

Does Anyone in your Household have Allergies to Animals?

Yes

No

Are all members of your Family agreeable to Fostering a Dog?

Yes

No

Have you ever Adopted a pet in the past?

Yes

No

Please List any Pets in your home current or past with name/type/breed/ and age. Include any deceased pets.

Have any pets currently in the home been known to be aggressive or bit any person or other animal? Explain

Have you ever lost, surrendered, or have an animal in your care pass away other than due to old age? Explain.

Veterinarian Name

Veterinarian Name

First Name

Last Name

Address

Address

Street Address

Street Address Line 2

City

State/Province

Postal/Zip Code

Country

Would you be willing to have a SDSC Team Member call your veterinarian for a reference check? (Please authorize vet to speak with us)

Yes

Now

Do you agree to keep the adopted dog up to date on all vaccinations as recommended by a licensed veterinarian?

Do you agree to keep the dog up-to-date on preventative treatments such as flea and tick /heartworm prevention?

We cannot guarantee a dog to be housebroken, are you equipped to train with love and patience?

Yes

No

What challenges do you expect to have with an adopted dog and how will you work to overcome them?

Have you had any experience with an emotionally or physically neglected or abused dog?

Yes

No

If Yes please explain

Do you have a fenced yard?

Yes

No

Partial

How do you plan to train your dog (what methods and resources will you use?)

If fenced, please give details on height, material, # of gates, are gates locked or lockable?

How many hours in a day would the dog be left alone? *

Where will the dog be kept when you are not home?

Crate

kennel outside

in the house uncrated

Other

If Other, please specify:

Are you willing to use a crate for a dog if recommended?

Yes

No

What are you plans to exercise your dog? Please list any parks near by or trails, how many walks a day, approximate length, activities such as agility *

Where will the dog routinely sleep?

What are your plans for emergency or alternate care for the dog if you are unable to care for the dog? Is there a relative or friend who can provide continuity of care in a safe and loving environment?

Can you ensure that measures will be taken to protect the dog from weather elements such as heat/sun/cold and rain exposure as well as any hazards such as roads, water, etc?

Do you agree to provide for the life ownership of the adopted dog?

Adequate food based on the dog's needs

Ample fresh water

Safe environment inside and outside

Routine and emergency veterinarian visits

Exercise & plan

Training and behavior management

Comforts such as dog beds as suited to the adopted dog

Love & Nurturing

Patience

References

References

Name

Name

First Name

Last Name

Address

Address

Street Address

Street Address Line 2

City

State/Province

Postal /Zip Code

Phone

Phone

Area Code

Phone Number

Email

Free Text

By sending this electronically,

I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in denial for adoption.

I certify that the above information is correct, and I understand that the information will be verified.

I understand that by submitting this form electronically,

I agree to release and covenant to hold harmless Saved Dogs and Sane Chicks and it's members from any claims, damages, costs, or actions incurred because of the care or actions of the adopted dog.

I accept full responsibility for the dog once adoption is consummated.

I agree to have Saved Dogs and Sane Chicks complete reference call checks and conduct a home visit inspection/interview if applicable to be able to approve my adoption application.

I agree that if I'm unable to care for the adopted dog anymore that I will contact a rescue or adoption facility to find a suitable home and I will not abandon the dog.

Date

Time

Your Name

Co-Applicant name (if applicable)

Full Name

Full Name

First Name

Last Name

Adoption Application - RESCUE DOGS