General Information
First and Last Name
Street Address
City/State/Zip
How long have you lived at this address?
E-mail Address
Main Phone
Work Phone
Employer
How long at current job?
Dog Information
Name of dog you are interested in adopting
Where did you find this dog? Please link to Facebook post, website post, etc.
Provide two references that are not members of your immediate family
Personal Reference #1 Name Phone Relationship Years known
Personal Reference #2 Name Phone Relationship Years known
About Your Home
Do you live in a(n)? House Apartment/Condo Townhouse Other If Other, specify here:
Your home is: Owned, by you and/or your spouse/life partner Owned, by someone else within the house Rented directly from the owner or through a mgmt co. Rented as part of a group of roommates Other (fill out the field below) If Other, specify here:
If renting, is your name on the lease? Yes No If renting, do you have landlord's permission to have a dog? Yes No
Landlord's name Landlord's phone number
Who shares your household? (check all that apply) Spouse/Life partner Roommates (list number below) Boyfriend/Girlfriend Other (list below) If Roommates or Other, specify here:
At what age do you feel children are responsible enough to take care of a pet without assistance (i.e. walk, feed, train)
Do you plan to move soon, and if so when?
Does anyone in the household have an allergy to dogs that you are aware of? Yes No
How many hours will your dog be alone during work days?
Where will your dog spend most of his/her day when you are home? Crate Garage Yard Enclosed Patio Indoors Other If Other, specify here:
Where will your dog spend most of his/her day when you are gone? Indoor/Outdoor (doggy door) Inside only Outside only Additional info:
When will the dog be inside? When will the dog be outside?
Where will the dog sleep at night? Indoor/Outdoor (doggy door) Inside only Outside only Additional info:
What rooms are off limits?
And your yard...
I do not have a yard at this time (skip to the next section)
What outside areas are available to the dog? (check all that apply) Front yard Back yard Dog house Garage Enclosed Patio Other (specify below) If other, specify here
Do you have a doggy door? Yes No
Is your yard fenced? Yes No
If yes... What type of fence? (wood, chain link, combo, etc) Fence height: Lowest point: Highest point:
Have you recently inspected your fences? Yes No Are they in good condition with no holes or loose access points? Yes No
Which of the following is used to secure your gate? Latch Padlock Keyed lock Other (specify below) No lock (specify below) If Other, specify here: If No lock, specify why here:
Who has access to your yard? (check all that apply) Gardener Housekeeper Pool man Delivery Utility Neighbor Postman Other (specify below) If Other, specify here:
Do you trust the dog not to get our while any workers are in the yard? If not, do you have a plan to keep your dog safe?
Your experience with dogs
How would you describe your dog owning experience? (check all that apply) I have had dogs of my own as an adult I grew up with dogs but not had one as an adult I have never had one and/or have limited experience Other (explain below) If Other, explain here:
Have you owned a rescue before? Yes No
If no, what are your thoughts about them?
Are you aware of the possible behavior issues that may be present with a rescue dog? Yes No
How are you prepared to address any issues should they occur? Please be specific.
How many dogs have you owned in the past 5 years?
Do you currently have any pets? Yes No If yes, please provide the following information for each pet.
How do you feel your current pet(s) will adjust to having a new dog in the house?
Have you had any experience with behavioral or medical issues with your previous or current pets? If yes, please explain.
If there are children in the household, please list their ages and current experience with dogs.
About this dog...
Why do you want to adopt a rescue?
Share your reasons for wanting a dog (check all that apply) Family member Gift for someone Protection Child's companion Companion for another pet Other (specify below) If Other, specify here:
How will you exercise your dog? How often?
Would you be willing to enroll your dog in obedience/training classes if needed? Yes No
How will you discipline your dog when it misbehaves?
What method do you intend to use to housetrain your dog? (check all that apply) Rub nose in offending spot Take out every couple of hours Crate training Consult professional Other (specify below) If Other, specify here:
In which of the following situations might you allow your dog off leash (check all that apply)? Publish park Dog park Beach Hike Neighborhood park Don't plan on it
Additional information
If your dog got out/was lost what would you do? Door to door Flyers Facebook Drive around looking Check local shelters Notify the chip company Other (specify below) If Other, specify here:
What food will you feed the dog?
Pets are an investment of your time and money. Can you afford to provide the medical care, grooming, proper diet, shelter, and exercise? Yes No
Are you able to make a long-term commitment to care for your pet for its entire life span, possible as long as 15 years or more? Yes No
What is your monthly budget for your dog?
Name and number of your veterinarian?
If you do not currently have a vet, would you like a referral? Yes No
If you move, what will you do with your dog?
Which of the following reasons might force you to give up your dog? (check all that apply) Excessive barking/neighbor complaints Digging Aggressive on leash Destructive chewing Biting/Aggression towards other dogs Divorce/Separation Shedding/Dirty Not trainable Allergies Poor watchdog Moving/Relocating House training problems Financial problems Biting/Aggression towards people Growling/Nipping at guests Excessive vet bills Having a baby New spouse/partner doesn't like dogs New pet doesn't get along with dog None of the above Other (specify below) If Other, specify here:
Have you ever had to rehome an animal? Yes No If yes, what were the circumstances? Please feel free to call us to discuss.
How long do you think it takes a rescue dog to decompress?
How do you think you can help your rescue dog decompress? Please be specific.
If you don't know techniques to help your dog decompress, are you willing to ask for help? Yes No
Additional comments
And finally...
Please read and initial each statement below:I understand that a home visit is required prior to final placement. I understand that a home visit does not guarantee placement. I understand that an adoption contract is required. I agree to provide my own collar, leash, and a personal ID tag at the time the dog is delivered to my house. I agree to notify the rescue immediately if my pet goes missing or is lost, and agree to follow their advice and use a professional to get my pet back.
* Adoption fees :
* I agree to Animal Rescue Relay's adoption fee which helps offset the cost of vaccinating, and microchipping my dog.
** For animals under 6 months of age, I agree to a spay/neuter agreement wherein I will fix the dog before 12 months of age ($75 will be refunded upon proof of spay/neuter)