Adoption Application Questions
A Canine Rescue Organization

Name of the dog you want to adopt

Full Name

Age

Occupation

Employer

Home Phone

Cell Phone

Work Phone

Email Address

Best time to contact me

Street Address

City

State

Zip

County

CO-APPLICANT

Full Name

Age

Occupation

Employer

Home Phone

Cell Phone

Work Phone

Email Address

Best time to contact me

How long have you been looking for a dog to adopt?

(To select multiple traits, hold down the CTRL key and click on as many traits as apply)

Why do you want to adopt this dog?

Will this be your first dog as an adult?

Which family member/s will be responsible for the dog's daily care (feeding, walking, etc.)

Approximately how many hours per day will your dog be left alone?

Where will the dog be when no one is at home?

Who will take care of your dog when you leave for extended periods of time (vacation, out of town, etc.)?

As your new dog adjusts to its new environment, a few “accidents” may occur. What methods would you use to help your new dog with any “accidents”?

How much time are you prepared to allow for your new dog to adjust to your home?

What traits would you NOT be able to tolerate in a dog?

(To select multiple traits, hold down the CTRL key and click on as many traits as apply)

If your new dog developed any of the traits that you would NOT be able to tolerate, what would you do?

Your PETS

Current Vet's Name

Current Vet's Phone Number

Please list the Name, Breed, Gender and Age of each pet currently living in your home.

Have you ever given an animal away to someone or relinquished an animal to a shelter?

If yes, what were the circumstances?  

Your HOME

How long have you lived at your current address?

Describe the neighborhood in which you live.

How would you classify your home?

If you rent your home...

CHILDREN or other persons living in the home

Adoption Application

APPLICANT