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Dog’s Information |
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Dog’s Name: |
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Dog’s Sex: |
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Dog’s Breed: |
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Personal Information |
(All personal information is kept strictly confidential.) |
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Full Name: |
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Age: |
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Address 1: |
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Address 2: |
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Address 3: |
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Phone #: |
Home:
Work:
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Best time to phone? |
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Email: |
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Lifestyle |
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Is your home rented or owned? |
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If rented, do you have permission from your Landlord? |
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Do you live in a house or an apartment? |
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Do you live with anyone? |
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If yes, do you have their permission to adopt? |
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Do you have or live with any children? |
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If yes, please list their ages: |
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Do you have a backyard? |
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If yes, does the backyard completely fenced in? |
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Do you work or attend school? |
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What is your annual household salary? |
$
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How many hours per day on average would the dog be alone? |
hours |
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Where would the dog stay while you are not at home? |
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Does anyone in your home or anyone who will have a lot of contact with the dog have any allergies? |
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Animal History |
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Do you currently own any pets? |
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If yes, please list their breed, age, and how long you have had them:: |
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Are all of your pets up to date on their vaccinations, if applicable? |
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Are your pets spayed or neutered? |
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If no, please explain why not: |
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Do any of your pets suffer from any medical conditions? |
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If yes, please list them below: |
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What pets have you owned in the last 10 years? Please list breed, how long you had them and what happened to them: |
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Have you volunteered with any animal shelters or rescues? |
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If yes, who and how long? |
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Have you ever adopted a dog before? |
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If no, do you know what to expect from an adopted dog? |
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Please explain what you are expecting |
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Where will the dog be kept during the night? |
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If you go on vacation, where will the dog go? |
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If the dog becomes sick, would you take it to the vet? |
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How much money would you be willing to spend on vet care in the case of an emergency? |
$
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Will you take the dog into the vet for an annual check up and shots? |
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If you were to die, or become seriously injured who would care for the dog? |
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What brand of food do you plan on feeding the dog? |
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Why are you looking to get a dog? |
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What do you know about the breed you are applying for? |
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What behaviour would you consider completely inappropriate in a dog? |
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How would you correct this behaviour? |
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For what reasons would you rehome or surrender the dog? |
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What actions would you take prior to deciding to surrender the dog? |
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How long do you plan to keep the dog? |
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Do you plan on letting the dog off leash? |
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If yes, where? |
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Do you plan on socializing the dog with other dogs? |
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If yes, where? |
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If you do not plan on socializing your dog, please explain why: |
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Have you, or anyone in direct contact with the dog ever been charged or investigated for an animal cruelty offense? |
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If yes, please explain: |
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References |
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If you have pets currently, what vet clinic do you use? |
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What is the name of your primary vet? |
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What is the vet’s phone number? |
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Can we call them as a reference? |
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Please list two references below: |
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1. Name:
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Age:
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Relationship:
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How long have you known them?
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Phone Number:
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Best time to call: |
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2. Name:
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Age:
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Relationship:
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How long have you known them?
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Phone Number:
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Best time to call: |
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I certify that I am 18 years of age or older. I certify that the information provided on this form is true & correct. In signing this document I am granting permission for Orphan Annie Animal Rescue to contact all stated references & veterinarians. I am financially and physically able to care for this animal. I understand that proper food, water, shelter, and veterinarian care is necessary & may be costly, and I am able to meet these requirements. I understand that a home visit is mandatory prior to adoption and a home visit or follow up call are made at two, four and eight weeks after the adoption. If upon inspection it is found that information contained in this application to be false, the Rescue retains the right to turn down your application or remove the animal from your premises without a refund of monies paid. The Rescue reserves the right to refuse an applicant due to our primary interest being the well being of the animal. A hard copy of your signature will be required at the time of adoption to certify the above information. |
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I Agree
I do not Agree
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