Adoption Application - Dogs/Puppies

First Name:
Middle Initial:
Last Name:
Age:
Occupation:
Street Address:
City:
County:
State:
ZIP:
Home Phone:
Work Phone:
Email Address:
Name of pet you are interested in adopting:
List any general questions you would like to ask about this pet:
Are you willing to allow a representative from Shelter Rescue to visit your home by appointment:
Reason for adopting pet:	watchdoog companion hunting dog
Please indicate where you live:	house apartment mobile home
Do you......:	own rent
If you rent, do your have the landlord's permission to own a dog/puppy?:
What is the apartment complex name?:
What is the landlord's phone number?:
How much is the pet deposit?:
How many times have you moved in the past 5 years?:
If you move, will your pet go with you?:
Would you ever consider moving somewhere that doesn't allow your pet(s)?:
Do you foresee any major changes in your life in the next 15 years (average lifespan of a dog) such as marriage, childbirth, health problems due to age, going away to college?:
If yes, please explain:
Do you or anyone in your household currently have any serious health problems?:
If yes, please describe:
Can you provide a permanent home for this dog/puppy for 10-15 years?:
What procedures will you use for housetraining?:
Do you have a fully fenced yard with no fence gaps?:
If yes, how high and what kind?:
If no, would you consider fencing all or part of it as a condition of adopting a dog?:
If no fence, how do you plan to keep the pet on your property?:
Number of adults in household?:
Relationship?:
Will this dog/puppy be a surprise for any family member?:
If yes, who?:
Do any family members have allergies?:
Do any children live in the house?:
If so, what are their ages?:
Number, type and age of pets currently in household?:
Do any of your current or did any of your past pets live primarily outdoors?:
If yes, please describe pet?:
Were all previous pets spayed/neutered?:
Are all current pets spayed/neutered?:
Do you know what heartworm disease is and how to prevent it?:
Is your current dog or was your previous dog on heartworm prevention medication?:
If yes, how often did  you give the heartworm medication?:
What brand did you use?:
What is your veterinarian's name and phone number?:
What do you expect annual pet care (vet care, medication, heartworm preventative, etc.) to cost yearly?:
How many dogs have you owned in the past?:
If any, please describe what happened to each of them (put to sleep, run over, died of old age, sold, given away, ran away, etc.):
Who will be responsible for the daily care and training of your new dog/puppy?:
How do you plan to prevent fleas and ticks?:
Are you aware of Frontline or Advantage?:
How many hours will the dog/puppy be home alone on a typical day?:
Where does your current dog stay when home alone during the day?:
Where will your new dog/puppy stay when home along during the day?:
Where do current pets sleep at night?:
Where will your new dog/puppy sleep at night?:
What percentage of time will the dog/puppy spend inside the house?:
Have you ever had a serious behavior problem with a previous dog?:
If so, please describe:
Do you have a doggie door?:
Would you consider installing a doggie door?:
Have you always kept an ID tag (other than a rabies tag) bearing your phone number on your pets?:
Are you willing to keep a collar and ID tag on all your pets including a new dog at all times?:
Under what circumstances do you think it is OK to leave a dog outside alone and unsupervised in an unfenced area?:
What circumstances, in your mind, justify giving up a dog?:
Have you ever given up a dog/puppy or had a dog/puppy for a brief period of time and it didn't work out?:
If yes, please explain the circumstances and what happened to the pet?:
Have you ever adopted a pet from a humane society?  if yes, please explain?:
If you date or marry someone who does not like or want your pets, what would you do?:
If your pet later developes a medical problem that becomes expensive, what would you do?:
If your pet later developes a frequent urination problem at the age of 12 and can't hold it when left alone, what would you do?:
If you are considering a long-haired breed, how often would the dog be groomed?:
Would he get haircuts?:
Would you do it yourself?:
Have a groomer do it?:
What type of food will you feed your pet?:
Has a dog or puppy died on your premises in the last 6 months of distemper, parvo or unknown causes?:
Please list names, addresses and phone numbers of 2 personal references?:
How did you hear about Shelter Rescue and Please Rescue Me?:

PROVIDING FALSE INFORMATION HERIN WILL RESULT IN THE FORFEITURE OF ADOPTION FEES AND ANY ANIMALS ADOPTED.