Dog Adoption Application

SOUTHERN ANIMAL RESCUE

DOG Adoption Application
Dog Name
Personal Information:
Name
Phone
Date
Age
Spouse/Partner Name
Phone
Address
City
State
Zip
County
Current Employer
Email Address
What qualities are you looking for in a dog?
Current Living Situation
Do you rent or own your home?

Own Rent
If you RENT or LEASE, please provide the following landlord/owner’s information:
Name
Phone Number
Do you have landlord’s approval to have pets?
What’s the pet deposit?
Type of residence (please check one):

House Apartment Duplex Mobile Home Farm Live with friend/relative Condo Other
How long have you lived at this address?
Are you planning to move in the next 6 months?
Are there any weight or breed restrictions where you live?
Is there a fenced yard?

Yes No
If yes what type? (height, chain link, wood etc)
How do you plan to exercise your dog?
What is the activity level of your household?

Quiet Active Moderately Active
Number of adults in home
Number of children living in home and ages
Number of grandchildren/visiting children and ages
Who will be the primary caretaker?
Does anyone residing in the house have any known pet allergies?

Yes No
If you must move from your current place of residence, what will you do with your dog?
What will you do if you decide to move to a place that does not allow pets?
Veterinary Information (for owned and previously owned pets)
Clinic Name
Phone Number
If you do not currently have a veterinarian, you will be asked to obtain one before the adoption is finalized.
Please list CURRENT PETS and Pets you’ve owned IN THE PAST 5 YEARS:
PET 1

Dog Cat Spayed/Neutered Still have pet No longer have pet
Name, Age, Breed
PET 2

Dog Cat Spayed/Neutered Still have pet No longer have pet
Name, Age, Breed
PET 3

Dog Cat Spayed/Neutered Still have pet No longer have pet
Name, Age, Breed
PET 4

Dog Cat Spayed/Neutered Still have pet No longer have pet
Name, Age, Breed
PET 5

Dog Cat Spayed/Neutered Still have pet No longer have pet
Name, Age, Breed
Are the pets you now own current on vaccinations?

Yes No
Are the records listed under the name on the application?

Yes No
If you no longer have the pet, what happened to it?
How do you plan to introduce your new foster dog/puppy to the other pets in your household?
Pet care philosophy and training
Why do you want to adopt a dog?
Have you ever surrendered an animal to a shelter?

Yes No
When?
Why?
How much $ do you plan to spend per year to care for your dog?
If your pet comes down with a serious medical problem in the future that is very expensive, what would you be willing to do? What could you realistically afford?
What brand heartworm and flea preventative do you use?
What brand dog food do you currently feed or will you feed?
How will you correct behavior problems in your dog if they occur?
How many hours a day will your dog be without human companionship?
Are you a frequent traveler?

Yes No
Who will care for your dog during vacations, business trips, etc?
Where will you keep the dog during the day when you are home?
Where will you keep the dog during the day when you are gone?
Where will you keep the dog during the night?
When do you think it’s okay to allow a dog off leash?
Where will you keep the dog during the night?
What are your house training methods?
Do you have experience with crate training?
Are you willing to attend obedience classes with your new dog?
How long will you allow your dog adequate time to adjust to a new home?
Have you ever had a situation where you had to find your pet another home because of a move, new baby or behavior problem, etc? Please explain:
Under what circumstances do you find it acceptable to find your dog another home? Check all that apply:

Moving Divorce Shedding Allergies Aggressive New baby, no time for dog Children not helping care for the dog Marking in the house Not getting along with other pets Behavior problems Increased work hours Medical problems Not getting along with children Destructive Behavior Other None
Please explain:
Have you ever had a serious behavioral problem with a pet? If so, what did you do?
What will you do if your dog has behavioral problems in the future?
Do you expect any major life changes in the next 10 years – marriage, children, etc?
How do you think these life changes will affect your pets?
Are you aware of the annual routine vaccinations recommended and those required by law for the health and protection of your dog? And do you plan to take your dog to the vet for yearly checkups and vaccinations?

Yes No
This dog/puppy is being adopted as: PLEASE CHECK all that apply.

House dog Outside dog Farm dog Gift Hunting dog Companion For a child Protection Companion for another pet Breeding
Will you commit to caring for your new dog for the next 10 - 15 years?

Yes No
Are you familiar with the dog responsibility and liability laws in your area?

Yes No
Do you understand that all adopted dogs must be spayed/neutered?

Yes No
Would you agree to an in-home visit with a volunteer before, during or after the adoption is approved?

Yes No
Please provide two personal references that we may call and verify the information above:
Name & Phone Number
Name & Phone Number
Check items you would like more information about.

House training Dog/Cat introductions Dog/Dog introductions Ordinances /Laws Dogs and Children Vaccinations Spaying/Neutering Training methods
By signing below, you agree that you are applying for this dog for yourself and no one else and this dog will be living only at the above address listed above.
Signature & Date
Signature & Date
Should be Empty:

SOUTHERN ANIMAL RESCUE