Clone of 4 Keeps Animal Rescue Dog Adoption Application-NEW

Full Name:*

First NameLast Name

Age:*

Street Address:*

City:*

State:*

Zipcode:*

E-Mail Address:*

Main Contact Number:*

Area CodePhone Number

Alternate Number:

Area CodePhone Number

Place of Employment:*

Employer Address AND Contact Information:*

List NAME, AGE, *and* RELATIONSHIP of everyone living in the house:*

Does anyone in your house have medical or allergy conditions? If yes, please explain:*

Is everyone in the house in agreement with adopting a dog?*

YesNo

How long have you been looking for a dog?*

Have you applied to adopt with any other rescue group(s)?*

YesNo

Please provide the name of these group(s) if applicable, AND the status of your application(s):*

Dog's name:

Dog's description:

Specific Age?

Specific Breed?

Do you prefer male or female?

Describe your ideal dog:*

Why do you want to add a dog to your family at this time?*

Why do you hope to adopt THIS particular dog?*

What makes YOU the best person/family to adopt this dog?*

Do you:*

ownrentlive with parents

If you own, please give homeowners' association contact info; if you rent, please give landlord's contact info:*

Do you live in:*

How long have you lived here? Please include previous address and length of time there if less than 1 year at current address:*

Do you or any friends or other family members smoke in the home, or in your vehicle?*

Is the yard fenced?*

yesno

If yes, describe type/height:

CURRENT PETS: Name, type/breed, age(s):*

Are they all up-to-date on vaccinations?*

yesno

Are they all up-to-date on annual heartworm tests and heartworm preventative?*

yesno

Are they all spayed/neutered?*

yesno

If no to any of the above, please explain why:*

How does a dog get heartworm disease, and how do you prevent it?*

How do you plan to prevent fleas & ticks on your dog?*

What brand(s) of food do you feed your current pet(s)? If you don't currently have a pet, let us know what brand of food you plan to feed your adopted pet. Please be specific.*

Do you feed dry food, wet food, or a mixture? Please be specific.*

Where do your current pets live? (inside/outside, please explain):*

How much time do your current pet(s) spend outside with you or a family member each day?*

How much time do your current pet(s) spend outside alone unattended each day?*

CURRENT VET INFO: Please list name, address and phone number:*

PAST VET INFO: Please list pet(s) name, their vet's name, phone number and city/state. Include pets alive & deceased.

Pet name- Vet name- Phone number- City/State

PAST PETS: Name, type/breed, age(s):*

Were they all up-to-date on vaccinations?*

yesno

Were they all up-to-date on annual heartworm tests and heartworm preventative?*

yesno

Were they all spayed/neutered?*

yesno

If no to any of the above, please explain why:*

Where did your pet(s) live? (inside/outside, please explain):*

What happened to your previous pet(s)?*

Where will the dog routinely live? (inside/outside, please explain):*

Approximately how many hours a day during each weekday will the dog be left alone?*

Approximately how many hours a day during each weekend day will the dog be left alone?*

Where will the dog stay when you are not at home? (i.e., crate, baby gated into laundry room, free roam of house, etc.)*

Where will the dog sleep? If in a crate, where will the crate be located? Please be specific.*

How much time will the dog spend outside with you or a family member each day?

How much time will the dog spend outside alone unsupervised each day?*

How much time per day are you able to provide your dog with exercise and attention?*

What type(s) of exercise and activities do you plan to do with your dog?*

Who will be the primary caretaker of the dog?*

If you DO have kids, how have you taught them to be "dog savvy"? What behaviors are acceptable or unacceptable by your kids with regards to the family dog?*

If you DON'T have kids, how would you expect other people's kids to behave with/around your dog?*

Who will be responsible for the dog in your absence?*

Do you plan to enroll your dog in obedience classes?

yesnomaybe

If not, please tell us specifically how you will meet your dog's ongoing need for training and socialization:*

How much training are you comfortable doing with your dog to improve manners such as housebreaking, jumping, stealing food, excessive barking, pulling on leash?

How much time are you prepared to allow your dog to adjust to his/her new environment and routines, AND for you to adjust to your new dog?

If a job or family situation forced you to move, what would you do with your pet(s)?*

Check as many as apply:*

Please check all that apply:

Please be specific:*

What Each Applicant Should Know

·IMPORTANT: Our adoption contract states that your adopted dog must be returned to us if you are no longer able to care for him/her.

Dogs will require some or all of the following vaccines/tests EVERY YEAR for the rest of their lives: DA2PLCPV/ (this vaccine covers distemper, hepatitis, leptospirosis, parainfluenza, parvovirus), Rabies (1 year or 3 year vaccines), Bordatella (kennel cough), Lyme (to protect against Lyme disease, transmitted to dogs by ticks), heartworm test (heartworm is transmitted to dogs by an infected mosquito) and monthly heartworm pills. The costs for these vaccines/tests can be $200 or more/year per animal.

· Note: Once you factor in food, trips to the groomer, dog sitters or kennel stays while you are on vacation; and any other injuries or illnesses, the cost of bringing an animal into your family can be as much as $500 or more a year; per animal. Please consider this before making a decision to bring an animal into your home and family.

Our dogs, unless otherwise stated, come with age appropriate vaccines, have been spayed/neutered and have been deemed healthy by a licensed veterinarian. However, we cannot guarantee the future health of any of our animals (this would be like you asking your doctor to guarantee that you will never get heart disease or cancer later in life); rescue dogs have unknown medical and behavioral histories.

· Adoption Fees for dogs and puppies vary according to costs incurred by the rescue.

All fees are subject to change without notice at our discretion. All fees are used to help continue our mission of preventing the euthanasia of companion animals.

Submitting an application does not obligate you to adopt nor does it guarantee the animal will be adopted to you/your family.

We do not work on a first-come, first-served basis. Applications on each animal
are fully-screened, then we pair each dog with their new family,

based on where we think the animal is best-matched and where they will be happiest.

· We cannot guarantee the age and breed of our rescue dogs. We depend on our veterinarians to help us make the best determination on age/breed of all our dogs, unless we receive written documentation from the shelter where the dog was surrendered.

· We reserve the right to deny any application without explanation.

We make every effort to process new applications as soon as possible.

We all work full-time jobs, and do volunteer rescue work on our lunch hours, evenings and weekends as time allows.

Thank you for your patience and understanding!

E-mail

Completion of this application in no way guarantees the adoption of this dog. Furthermore, any falsification of information will result in the immediate denial of this application. By signing (electronically), I declare that I am at least 21 years of age.*

First NameLast Name

If you/your family are approved for this adoption, would you object to us calling or visiting in the future to check on the animal's status?*

yesnopossibly

Date

MonthDayYear

4 Keeps Animal Rescue Dog Adoption Application-NEW2

Please Note: All questions are asked for the purpose of finding the best fit placement for each of our rescued animals; and to promote their best health, happiness and welfare.

Desired Dog Information:

Describe your Living Situation:

About your Current Pets:

PLEASE NOTE: In order to continue processing your application, we will need to contact your current AND prior veterinarian(s). Please CALL THEM to give them permission to speak with us!

About your Past Pets:

Care of your Adopted Dog:

PLEASE NOTE: Obedience classes are as much for the new family as they are for the dog, in helping to teach everyone to communicate clearly with each other.

What behaviors are you NOT WILLING to work with your new dog on, whether now or at any point in your dog's life? (please check all that apply):

PLEASE NOTE: Many of the behaviors listed are typical and expected in puppies and young dogs. Please be prepared and committed to work on training with your puppy, so he/she develops into a happy and well-behaved adult dog!

How would you discourage any of the above unwanted behavior(s) in your adopted dog?

Please answer this honestly!

I understand that:

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