Dog Adoption Application

Name:	Date: - -
Address:
City:	State: Zip:
Home Phone:	Work Phone:
Email Address:

1. Name of or type of dog/puppy you are interested in:
2. Why do you want this dog?
3. Do you have a fenced yard?   Yes No
4. Do you have a crate?   Yes No
5. Do you have an outdoor pen? Yes No
6. Are there any children in your home?   Yes No
         -If yes, what are their ages?   , , and
7. Who will be responsible for the daily care of your new dog/puppy?
8. Are you 18 years of age or older?    Yes No
9. How many people live in your household?
10. Do you live in a:
11. Do you own or rent your home?   Own Rent
         -If rental, are dogs/puppies allowed?   Yes No
12. Do you currently own any dogs?   Yes No
         -If yes, ages/breeds:
13. What other pets live in your home?
14. What is your veterinarian's name AND the clinic name?
15. Are all of your pets current on their vaccinations?    Yes No
16. Are all your pets spayed or neutered? Yes No
         -If no, why not?
17. Are all your dogs on monthly heartworm preventative?    Yes No
         -If no, why not?
18. Where do your current dogs live?
           -Where will the new dog live?
19. Where do your current dogs sleep?
           -Where will the new dog sleep?
20. What type of protection/supervision will your new dog have when going outside to potty?
21. How many hours a day will your dog(s) be left alone?
22. Do you know about crate training? Yes No
         -Do you plan on using this method to housebreak? Yes No
23. Would you consider adoptiong a companion for your dog/puppy if it's your only pet? Yes No Maybe
24. What arrangements will you make for your pet if you need to be away from home overnight?
                 -If other, please explain:
25. How will you handle destructive behavior?
26. How do you feel about debarking, ear cropping, or tail docking your new dog?
27. Have you ever had to give up a dog before?
         -If other animal, what type?
                 - If yes, why and what did you do with the animal?
28. What happened to your most previous dog?
29. Has a dog die on your premises in the last 3 months of Distemper, Parvo, or unknown causes? Yes No
                 - If yes, please explain:
30. Are you willing to go to the expense and trouble of taking your new dog/puppy to a veterinarian for full preventative and medical care at least once a year? Yes No
31. Do you have access to reliable transportation of your own? Yes No
32. Is anyone in your household allergic to animals of have asthma? Yes No
33. Will you notify us if the dog develops any health problems of illnesses at the onset of the problem? Yes No
34. If you are unable to keep your dog for any reason will you return the dog to us? Yes No
35. Will you allow a visit from an authorized representative of jennifer's Pet Rescue, Inc. to see how the dog is doing in its new home by appointment? Yes No