Dog Adoption Application Animal Name * Your Information Name * First Name Last Name Email * Phone * (###) ### #### Are You 21 Years of Age? * Yes (21+) No Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Driver's License Number * Birthdate * MM DD YYYY Employer * Years at Current Job * References Information: You are required to submit two references that are NOT family members. Reference 1 * First Name Last Name Relationship to you * Reference Phone Number * (###) ### #### Years Known * Reference Name 2 * First Name Last Name Reference Phone Number 2 * (###) ### #### Relationship * Years Known * Home Information Home Information * House Apartment Condo Townhouse Your Home is: * Rented directly from the owner/management company Owned by you Other If OTHER please explain: If renting, is your name on the lease? Yes No If renting, do you have your landlord's permission to have a dog? Yes No Landlords Name First Name Last Name Landlord's Phone (###) ### #### Who shares your home? * Spouse/Life Partner Roommate Boyfriend/Girlfriend/Other Partner Other Are there children in the home? Yes No If there are children, How many and how old are they? At what age do you feel children are responsible enough to take care of a pet without assistance and supervision? (walk, feed, train) * NO rehoming agreement if your present relationship/living arrangement were to change and you were no longer able to care for the animal do you agree to bring the dog back? * Yes No Home Information Do you plan to move soon? * Yes No Maybe If Yes, Where to? Is anyone in your household allergic to animals that you are aware of? * Yes No Maybe Is someone home during the day? * Yes No Maybe How many hours will your dog be alone each day? * Where will your animal spend most of their day when you are home? * Indoors Outdoors Enclosed Patio Where will your dog stay when they are home alone * Inside Outside Crate/Kennel Specific Room Run The House When will the animal be inside? * When will the animal be outside? * Where will the dog sleep at night? * Yard Information (if Applicable) Do you have a yard? Yes No How big is your yard? Small Medium Large What outside areas are available to the animal? Front Yard Backyard Enclosed Patio Dog House Garage Dog Park None If NONE Please Explain: Do you have a doggy door? Yes No I plan to get one. Is your yard shared with neighbors? Yes No Sometimes is your yard fenced? Yes No How tall is your fence? (if applicable) have you recently inspected your fences? (Last 6 weeks) Yes No Is your fence in good condition with no holes or open areas? Yes No Which of the following is used to secure your gate? Latch Padlock Keyed Lock Other If OTHER Please Explain: If your gate does not have a lock, are you willing to install one? Yes No Maybe Who will have access to your yard? (Check all that apply) No one but me Gardener Housekeeper Pool Guy Delivery Postal Worker Utility Neighbor Other If yes to any where will your dog be kept while they are working? Do you trust your workers not to let the dog out? Yes No Dog owning experience Describe your dog owning experience * Pet History How many pets have you owned in the past 5 years? * What happened to the other pets? * Do you currently have pets? Yes No If yes, please list your pet's type, breed, sex, age, spay/neuter status, if not spayed/neutered why? I believe my pets will adjust well to a new dog Strongly Disagree Disagree Neutral Agree Strongly Agree Do your current pets have behavioral issues? Yes No If yes, please explain If there are children in the home please describe their experience with dogs Reasons for wanting a dog Please select your reasons for wanting a dog * Family Pet Gift to someone else Protection/Guard Dog Companion Child's Companion Companion for another pet Other Will you exercise your dog Yes No How will you exercise your dog? * How often? * If needed, are you willing to enroll your current pet in obedience classes? * Yes No Maybe Not Needed How will you discipline your dog? * What methods do you intend to use to house train your dog? * Rub nose in offending spot Take out every couple of hours Crate training Consult professional Other Which of the following situations would you allow your dog off leash? * Public Park Dog Park Beach Hike Neighborhood Walk Back Yard Front Yard Other Additional Information If your dog were to get out/lost what would you do? * What type of food will you feed your dog? (Specify brand if known) * Would you like a food recommendation? * Yes No Can you afford to provide medical care, grooming, proper diet, and exercise for your new dog? * Yes No Are you able to make a long-term commitment to care for your pet for its ENTIRE lifespan, which could be 15+ years? * Yes No What is your monthly budget for your dog? $ Who is your veterinarian? * Would you like a vet referral? * Yes No If you move what will you do with your dog? * Which of the following reasons would force you to give up your dog Excessive Barking Aggressive On Leash Destructive Chewing Digging Divorce/Separation Allergies Shedding/Dirty Not Trainable Poor Watchdog Moving/Relocating House-Training Problems Biting Financial problems Growling/Nipping at Guest Excessive Vet Bills Chronic Illness Having A Baby Nips or Bites at Children New Spouse or Partner Doesn't Like Dogs Pets Aren't Getting Along None of the Above Other Additional Comments as to why you wish to adopt this dog: Pit Bull Applicants Only Have you ever owned a pit bull before? Yes No If no, what is your experience with them? What do you like about this breed? Are you aware that dog-aggression issues may be present in this breed? Yes No How are you prepared to address this should it arise? What type of training are you interested in doing with your pit bull? May we complete a home visit? Yes No Please type your FULL NAME below each statement below This is LEGALLY BINDING I understand that a home visit may be required prior to approval * FULL NAME First Name Last Name I understand that a home visit does not guarantee placement * FULL NAME First Name Last Name I agree to provide my own collar, leash, and personal ID tag at the time of completing adoption * FULL NAME First Name Last Name WE RESERVE THE RIGHT TO REFUSE ADOPTION TO ANY APPLICANT FOR ANY REASON AND WE MAY OR MAY NOT INFORM THE APPLICANT OF THE DENIAL REASON. THIS QUESTIONNAIRE BECOMES APART OF OUR CONTRACT Thank you!
