One at a Time K-9 Rescue Adoption Application

Name of dog applying for *

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

List preferences you have in adopting a dog (age, sex, breed, personality, size etc.) *

Are you prepared for the 10+ year commitment of owning a dog" *

If your dog needs emergency medical treatment, can you afford to pay for it? *

Why do you want to adopt a dog? *

0/250 characters

What do you think are the most important responsibilities in owning a dog? *

0/250 characters

Have you adopted from a shelter or rescue in the past? *

Please describe any pets that are currently with you (type, age, sex, altered status) *

Are all your current pets up to date on vaccines, heartworm test/and or prevention? *

Please describe any pets that are no longer with you (type, age, sex, altered status). *

Please describe previous pets and why they are no longer with you: *

Veterinarian name: *

Vet Phone Number *

How many people reside in your household?

Adults *

Ages *

Children *

Ages *

Your Occupation *

Spouse/ Partners Occupation

List any allergies you or a member of your household have: *

Does anyone smoke? *

Yes

Who will primarily be responsible for feeding, housebreaking and training? *

Does this person have any physical limitations that could prevent them from properly caring for the dog? *

Are you willing to work with issues the dog may have? *

What issues are you not willing to work with, if any? *

Do you own or rent your residence? *

Own

Rent

Landlord FirstName

Landlord Last Name

Landlord Phone Number

Does your residence have a yard? *

Yes

Is your yard fenced? *

Yes

Partially Partially

If your yard is fenced, provide type, size and height: *

If no fence, how do you plan to keep the dog safe/contained? *

Where will the dog stay during the day? *

Indoors

Outdoors

Both

Where will the dog stay at night? *

Indoors

Outdoors

Both

Approximately how much time will the dog spend outside each day? *

Will anyone be home during the day? *

Yes

When no one is home, where will the dog be kept? *

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

Where will the dog sleep? *

If you move, what will happen to the dog? *

What type/brand of food do you plan to feed the dog? *

How will you housebreak the dog, if required? *

How frequently will the adults be gone away from home on business/vacation trips? *

Where will the dog stay during these trips? *

References

First Name *

Last Name *

Phone Number *

Relationship *

First Name *

Last Name *

Phone Number *

Relationship *

First Name *

Last Name *

Phone Number *

Relationship *

I represent that the information that I have provided on this form is the truth to the best of my knowledge and belief.

Signed: *

clear

Date: * +

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