Dog Adoption Application

To help ensure the best possible placement of our rescued animals, and in order to determine that the proposed adoption is in the best interest of the animal, you, and your family, please complete each of the following questions. All information will be kept confidential.

Name of dog you wish to adopt: A value is required.
First Name: A value is required.
Last Name: A value is required.
Address Street 1: A value is required.
Address Street 2:
City: A value is required.
Zip Code: A value is required.Invalid format. (5 digits)
State: Please select a valid item.Please select an item.
Home Phone: A value is required.Invalid format..
Daytime Phone: A value is required.Invalid format.
Cell Phone:
 
HOUSEHOLD INFORMATION
Number of Adults (over 18 years) A value is required.Invalid format.
Number of Children (under 18 years) A value is required.
Ages of children A value is required.
Who in the household will be the pet’s primary caregiver? A value is required.
Have allergies to animals been a problem to any household member?
Please make a selection.
Is shedding a concern?
Please make a selection.
Are all family members aware that you are considering adopting a pet?
Please make a selection.
Do they all approve?
Please make a selection.
   
Do You Live In :



Please make a selection.
   
Do you ?


Please make a selection.
   
What best describes your street location:



Please make a selection.
If other, please specify.
   
What is your employment status?



Other

Please make a selection.
   
The cost of caring for one dog is at leat $500/year.  This includes food, litter, vaccines, flea treatment and vet bills. Are you able and willing to pay this cost?

Please make a selection.
 
PET HISTORY
How many pets do you have now? A value is required.Invalid format.
Number of Dogs
Number of Cats
Other, please provide type and number.
Are they current on their vaccinations? No
Please make a selection.
   
If you own dogs, have they been socialized with cats?
Please make a selection.
   
Name of current veterinarian: A value is required.
 
ADOPTION INFORMATION
For what reasons would you like
to adopt this dog?



   
Do you have a fenced yard?

Please make a selection.
   
If yes, what type of fence?
Fence height
   
Will this pet be an:


Please make a selection.
   
Where will this dog be when you are home? A value is required.
   
Where will this dog stay when you are away? A value is required.
   
Where will the pet spend most of its time?






   
Where will your new pets main sleeping quarters be?
   
Which of the following reasons would prompt you to give up your dog?
(choose all that apply)
Excessive Barking
Biting/Scratching Family Member
Poor Guard Dog
Planning on Having a Baby
Allergies
Not Friendly with Guests (barking, hiding)
Aggressive with Dogs/Cats
New Spouse/Partner doesn't Like Dog
Biting
Chewing on Furniture or Carpet
Divorce
Shedding
Financial Problems
Won't always go outside to pee
Excessive Veterinarian Bills
Aggressive with other dogs
Dog's Health Problems
None of the above
   
   
AGREE TO TERMS
Click Here to Read Terms

By checking the box below, I acknowledge and certify that:

  • I have never been convicted of any violation of an ordinance or statute enacted pursuant to animal abuse, neglect or cruelty.
  • That Rez Animal Resources & Education makes NO GUARANTEES OR WARRANTIES REGARDING THE HEALTH OR TEMPERMENT OF ANY ADOPTED ANIMAL.
  • Rez Animal Resources & Education is not responsible for any medical costs incurred by me on behalf of any adopted animal.
You must agree to terms in order to complete the application.
Date: A value is required.

Please check above to make sure are required fields are filled in before submitting.