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Adoption Application - Dogs/Puppies

Shelter Rescue's goal is to place our foster pets in permanent, responsible homes that meet the needs of the individual companion pet and, at the same time, match you with a pet that is suitable for you, your lifestyle and home environment.
Please fill out the following information and click on the SUBMIT key at the botton of the page.  In order for your application to be considered, ALL questions much be answered. 
Thank you!

First Name:
Middle Initial:
Last Name:
Street Address:
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:
Please indicate where you live:
Do you......:
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?:
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?:


The goal of Shelter Rescue and Please Rescue Me is to try and place our companion pets in permanent, responsible homes that meet the needs of the individual pets and, at the same time, match you with a pet that is suitable for you, your lifestyle and home environment.  We are not a dog pound or government agency.  We are a private non-profit organization and animals in our custody can be adopted only to approved families.  All contracts are legal and binding.  Therefore, we reserve the right to approve or deny any adoption to anyone based on our extensive experience in placing companion pet.

Thank you.