Dog/Puppy Adoption Application

Dog & Puppy Adoption Application

A note to the applicant: The volunteers of TMHPR strive to match each pet with the home perfectly the first time. We ask a lot of questions, but by providing the following information, we should be able to ensure the dog is a good match for you and your family. Thank you in advance for taking the time to complete this application. Your application must be completed in full to be considered.
Today's Date *

Month Day Year
Interested in *
Pet's Name
Applicant Information
Full Name *

First Name Last Name
Applicant Date of Birth *

Month Day Year
Please Note: All Applicants/Adopters must be 21 years of age or older.
Spouse/Significant Other

First Name Last Name
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Home Phone *
Mobile Phone *
How did you hear about Take Me Home Pet Rescue? *
If you chose "other" above, please fill out this field
Share the name of the person or place you heard about TMHPR
Household Information
Number of Adults living in the home? *
Have all adults consented to adopting this pet? *
Number of Children living in the home? *
Ages of Children
Living Situation *

House Apartment Condo/Townhome
Living Situation *

Rent Own
How long have you lived at this address? *
What type of fence do you have? *
Is your fence secure? *

Yes No Unsure
What is the height of your fence?
Do you have a pool? *

Yes No
If you rent, we require consent from the Owner/Landlord/Complex indicating approval to take the dog onto the property.
Name of Owner/Complex (if rental)
Phone of Owner/Complex (if rental)
Employment Information
Employer *
Employer's Address
Employer's Phone
Spouse/SO's Employer
Your Current/Past Pets
Have you adopted a pet before? *

Yes No
If yes, from which organization?

Please List and Describe your Current and Past (within last 5 years) Pets

	Name	Dog/Cat	Male/Female	Spayed/Neutered (yes/no)	Breed	Approx. Weight	Age	Up to Date on Vaccinations?	On Heartworm Prevention?	Living/Deceased	Currently Have?
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Pet 6

Your Veterinarian

Please list the clinic/veterinarian contact information who has cared for and treated the pets listed above. By listing the clinic contact info, I authorize TMHPR to inquire about the health status of my current animal(s) as well as any deceased/no longer owned animal(s) on the records under my/our name. I authorize release of vaccination records, heartworm preventative purchases, and whether or not the animal has visited a clinic in the last 12 months. If there are multiple clinics, please list additional contact info in the "additional comments" section at the end. **Please contact your veterinarian and inform them that we will be calling to verify and that they will need to be able to release this information to us.**
Do you have a current Veterinarian *

Yes No
Clinic/Veterinarian Name *
If you don't have a vet yet, please state that.
Clinic Address
Clinic Phone
Plans For This Dog

This information helps us to make the best fit for the dog's personality and needs with the adopters lifestyle.

Please Map Out A Typical Week *

	Away from home less than 5 hours	Away from home 5-9 hours	Away from home more than 9 hours	Not away from home
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Based on the time-frame indicated above, please describe a typical day for a puppy/dog in your home. Please be specific, especially the during the time you are away from home.
A typical day would be: *
Where will this dog live? *
How will this dog be cared for when you are out of town? *
If you move, what will you do with the dog? *
What will happen to the dog if you are no longer able to care for it? *
Have you ever taken an animal to a shelter? *

Yes No
If yes, please explain.
References
Please list at least 2 non-relative personal references). *
Include Name, Phone Number, and Relationship
Comments/Additional Information
How did you learn about this pet?
Please fill in any comments or additional information here
Should be Empty:

Dog & Puppy Adoption Application

Applicant Information

Household Information

Employment Information

Your Current/Past Pets

Your Veterinarian

Plans For This Dog

References

Comments/Additional Information