Apply to Adopt

Name *

Date of Birth *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Telephone Number (primary) *

Phone number (alternative)

Email Address *

Confirm Email Address *

Emergency Contact

Emergency Contact Number

Do you own or rent your property? *OwnRent

If renting, do you have your landlord's permission to have a dog?YesNo

Landlord's Name

Landlord's Contact Number

Landlord's Email Address

Type of Property *HouseFlat/ApartmentOther

Do you have a fenced yard/garden? *YesNo

If you have a yard/garden what is the type and height of the fence/wall?

Number of adults in the household *

Number of children in the household *

Any children under 5? *YesNo

Any children under 12? *YesNo

Has everyone in the household agreed to adopt a dog? *YesNo

Does anyone in the household have pet allergies? *YesNo

Do you currently have any other pets? *YesNo

Please give details *

Have you had pets in the past? *YesNo

If yes, what happened to them?

Current or past vet practice

Phone number of past or present vet practice

Name of dog you are interested in (if any)?

If no specific dog, please detail what you are looking for in a dog

How many hours will the dog be left alone per day? *

Where will the dog stay during the daytime? *

Where will the dog sleep at night? *

Who will have primary responsibility for the dog? *

Are you prepared to work with a dog that has separation anxiety? *YesNo

House training needs? *YesNo

Behavioral challenges? (reactivity, leash pulling, etc) *YesNo

Why do you want to adopt a dog? *

Are you prepared for the financial and emotional commitment of dog ownership? *YesNo

How much monthly budget can you allocate to your dog? *

If, for any reason, you are no longer able to keep your dog, are you prepared to return it to our rescue? *YesNo

Do you have any health conditions that could prevent you from caring for your dog? *YesNo

If yes, please give details

Who would care for your dog, if you become unwell? *

Please give name and contact details of two references (non-family) *

Adoption Info

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