ADOPTION APPLICATION | Pet Aid USA

About YOU

First Name

Last Name

Date of Birth

Email

Driver's License

Street Address

City

State

Zip

Home Phone

Cell

Work

Employer (optional)

How long at current job (optional)

Provide two references that are not members of your immediate family:

Personal reference #1

Phone

Relationship

years known

Personal reference #2

Phone

Relationship

years known

What Dog Are You Applying For?

Name

Breed

Shelter ID (optional)

About Your Home

Your home is

Owned, by you or your spouse/life partner

Owned, by someone else within the house

Rented directly from the owner or through a management company

Rented as a part of a group of roommates

Other

Do you live in

House

Apartment/Condo

Townhouse

Other

If Other

If renting, is your name on the lease? (Yes / No) If "No" please explain

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

Who shares your household?

Are there children in the home? (Yes/No) If yes, how many? How old?

At what age do you feel children are responsible enough to take care of a pet without assistance? (i.e.walk, feed, train)

If your present relationship/ living situation were to change and you were no longer able to care for the dog, a new application must be submitted and approved in order to transfer ownership. Initials:

Do you plan to move soon?

Does anyone in your household have an allergy to dogs that you are aware of?

Is someone home during the day? (Yes/No) If yes, who?

How many estimated hours will the dog be alone each day?

Do you have a secure fenced backyard and How high is the fence?

When will the dog be inside?

When will he/she be outside?

Where will the dog stay when he/she is home alone?

Indoor/outdoor (doggy-door)

Inside only (specify): Run of the house

Inside only (specify): Crate

Inside only (specify): Specific room(s)

Inside only (specify): Outside only (specify):

Inside only (specify): Yard

Inside only (specify): Garage

Inside only (specify): Enclosed patio

Inside only (specify): Other

Where will the dog sleep at night?

Indoor/outdoor (doggy-door)

Inside only (specify): Run of the house

Inside only (specify): Crate

Inside only (specify): Specific room(s)

Outside only (specify): Yard

Outside only (specify): Garage

Outside only (specify): Enclosed patio

Outside only (specify): Dog house

Outside only (specify): Other

Where will your dog spend most of his/her day when you are home?

If Other or Specific room(s)

What rooms are off limits?

About Your Yard

Do you have a yard?

What outside areas are available to the dog? (check all that apply)

Do you have a doggie door?

Yes

No

Is your yard shared with neighbors?

Yes

No

Is your yard fenced?

Yes

No

What is the type of fence?

Fence height? Highest point - Lowest Point

Have you recently inspected your fences?

Are your fences in good condition with no holes or loose points?

If your dog will have free access to a fenced yard, where is it located?

Which of the following is used to secure your gate?

If your gate does not have a lock, are you willing to install one?

Who has access to your yard? (check all that apply)

Do you trust your workers not to let the dog get out?

If yes, where is the dog kept while they are working?

About Your Experience with Dogs

How would you describe your dog experience?

I have had dogs of my own as an adult

I grew up with dogs or have worked with them but have not had my own as an adult

I have never had one or have limited experience with dogs

Other

If Other

How many dogs have you owned/fostered in the past 5 years?

What happened to the other dog(s)?

Do you currently have pets?

YES

NO

If yes, please complete the following:

How do you feel your current pets will adjust to a new dog in the house?

Have you had experience with behavioral or medical issues with your previous or current pets? If yes, please describe:

If there are children in the household, please describe their experience with dogs:

About this Dog

Why do you want to adopt a rescued dog?

Share your reasons for wanting a dog (check all that apply)

If Other

How will you exercise your dog?

How often?

What type of training are you interested in doing with your dog?

Have you or would you be willing to enroll your current dog(s) in obedience classes?

How would you discipline your dog if he or she misbehaved/ chewed household items?

What method do you intend to use to housetrain your dog? (check all that apply)

Rub nose in offending spot

Take out every couple of hours

Crate training

Consult professional

Other

In which of the following situations might you allow your dog off leash?

If Other

If your dog develops behavioral problems, what will you do?

Additional information

If your dog got out/was lost, what would you do?

What food will you feed the dog? (Specify brand if known)

Would you like food recommendations?

Yes, please

No, thanks

Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, shelter, and exercise for your new dog?

Yes

No

Other concerns:

Are you able to make a long-term commitment to care for your pet for its entire life span, which could be as long as 15 years or more?

Yes

No

Other concerns:

What is your monthly budget for your dog?

Who is your veterinarian (name and phone)?

If you do not currently have a vet, would you like a referral?

If you move, what will you do with your dog?

Paragraph

Which of the following reasons might force you to give up your dog? (Check all that apply):

Additional comments about why you would like to adopt this particular dog:

Is there anything else you would like to share about with us?

and finally…

Please read and initial each statement below:

I understand that a home visit is required prior to final placement

I understand that a home visit does not guarantee placement.

I agree to provide my own collar, leash and a personal ID tag at the time of completing the adoption contract.

I can give a gift of $__________ to help offset the costs incurred preparing this dog for adoption. (Inability to make a donation does not disqualify an applicant from consideration.) I understand that any donation or contribution is a gift freely given, not a purchase price for a dog.

I commit to never surrender the dog to a shelter and in case of any difficulties always contact the rescue organization.

We reserve the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of our contract.

Type your FULL Name as your digital signature

Gift Amount

Date Today