Dog Application Form

Greenmore Farm Animal Rescue

Dog Adoption Application

Below are initial requirements before filling out the Application: Please read carefully!
- PLEASE USE A COMPUTER OR LAPTOP to fill out the form and allow for 5-7 business days for us to review your application. If you have not gotten an email during the alotted time; please check your spam folder.
- YOU MUST BE at least 21 years of age and a homeowner or renter to apply to adopt.
- Households with children 10 and under must have a physical fence attached to the home. If you have an INVISIBLE FENCE and children over 10, the fence is only appropriate for dogs 6 mos. and older
- IF YOU ARE A FIRST TIME DOG OWNER, and/or you have children 5 and under, your application will only be reviewed for dogs over one year of age. In addition, ownership of a dog can cost $50 to $100 a month not including emergency medical needs.
- ALL PETS IN THE HOUSEHOLD past and present must be spayed or neutered, current on vaccinations, and have a history of yearly wellness visits in the applicant(s) name. Please call your Vet now to confirm your pets are current before completing this application. At that time please authorize them to speak with us regarding your pets medical records.
- Please note: We reserve the right to refuse adoption to anyone. Please be advised that we will not adopt to persons who mislead or fail to provide accurate information on the application.
Greenmore Farm Animal Rescue is a 501c3 Organization. Non-refundable adoption donations are as follows, which includes microchipping and a martingale collar: (All donations are tax deductible)
- Dogs: Cash $395.00 (credit/debit card $420.00)
- Puppies: Cash $425.00 (credit/debit card $450.00) there is also a $75 deposit required; refundable after proof of spay/neutering.
- Purebred, designer breed and XL dogs: Cash $450.00 (credit/debit card $475.00)
Your Name*

First Name Last Name
NAME OF DOG INTERESTED IN: YOUR APP WILL NOT BE PROCESSED if you don't specify a dog/puppy at our Rescue.*
Please describe what you are looking for in a dog:*
Size of dog interested in lbs:*
Age range you are looking for:*
What is your time frame for adopting a dog:*
Where did you hear about us?*
Home Phone*

Area Code Phone Number
Cell Phone*

Area Code Phone Number
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail*
Applicant Employment Information*

Full timePart timeRetiredStudentOtherWork from homeStay at home Mom/Dad
Applicant Occupation*
Your AGE*
Family Members
Are there any pet allergies in your house hold?*

YesNo
Spouse/Partner name:*

First Name Last Name
Spouse/Partner Occupation*
Spouse/Partner Cell phone
Spouse/Partner AGE
NAMES and AGES of children/people living in your home*
Are you the homeowner/renter?*

YesNo; If you are not the homeowner or renter we will not process your application
Have your children been exposed to dogs before and what experiences have they had with dogs?*
Tell us a little about your family. What do you like to do for fun, what activities do you enjoy, what hobbies do you have, and how do you see your new dog fitting into these activities? Tell us why you would be a good pet owner.*
What type of home do you reside in:*

Single family homeTownhouseCondoApartmentTwinMobile HomeFarm
Do you own or rent: If you rent, please provide landlord/leasing office name and number. We cannot approve your application without approval from your landlord. If you have a landlord, condo, or HOA it is your responsibility to follow all pet related rules.*
Home / Environment / Care / General Information
Home Atmosphere*

Grand Central StationActiveAveragePeaceful/Quiet.
How many HOURS each day will your pet be home alone? M-F & Sat-Sun*
While you are out where will your dog be kept? *

Free inside houseConfined in crateInside a closed roomDoggie day careGated area inside houseIn yardDog walker coming inWith friends or family
Do you CURRENTLY have a physical fence completely enclosing your back yard? If yes, please check all that applies. Pictures of your fence will be requested.*

YesNoSplit railSplit rail w/ wire meshChain linkPrivacy-Wood or VinylAluminum or IronVinyl decorativeSix Foot High Fence / StockadePicket
What are your CURRENT accommodations for keeping your dog safe while outside?*

Fenced inInvisible fence: Verification may be requiredLeash and walksPatio areaGarageOutside dog kennelLoose in yard unattendedTie out cable or Trolley
It may take several weeks to months for a rescue to adjust and begin to show their personality and all rescue dogs will require some amount of training. What is your plan for training your new dog? How will you handle any difficulties with training or undesirable behavior?*
Senior Applicants: In the event that you are no longer able to care for the dog; please designate a care surrogate. Name and relationship; number to contact*
Dog Experience as an Adult*

First time ownerHave owned dog(s) before
Tell us about your experience with dogs:*
Have you ever had to surrender/rehome/return a dog before:*

YesNo
If yes, please tell us why
How many pets do you currently own?
Dog (s)
Cat (s)
Name, Age and breed of Animals indicated above. Also, please include deceased pets and the year they passed.
Dog (s) Name(s) and ages*
Cat (s) Name(s) and ages
Are your current pets spayed and/or neutered?

YesNo
Are your current pets vaccinations up to date?

YesNo
If you answered No to any of the questions above, please explain:
Is your current dog well socialized with other dogs? Yes or No, please explain.*
Personal References: Please list the names and phone numbers of 3 people who can speak to your ability to care for a pet. Only one reference can be a family member. Please inform your references that we will be calling them.
1) Name: Relationship*
Phone Number (please include area code)*
2) Name: Relationship*
Phone Number (please include area code)*
3) Name: Relationship*
Phone Number (please include area code)*
Veterinary Contact Information
Current Veterinarian Name/Name of pet seen:*
Phone Number (please include area code)*
Owner name on veterinarian records: *
Relationship to Owner if not self:*
Previous Veterinarian Name/Name of pet seen:
Phone Number (please include area code)
Owner name on veterinarian records:
Relationship to Owner if not self:
Alternate Vaccination Facilities used: Clinic, Pet Store, etc. If records are not available you may be required to provide a copy of your vaccine history.
Phone number for above facility (please include area code)
My signature below certifies the following:

That all the house hold members are listed on this adoption application and that each member residing at this address has never been convicted of animal cruelty, abandonment, neglect, or abuse.

That I am at least 21 years of age and the homeowner or renter, and that I am willing to spend the time and money necessary to provide medical treatment, proper nourishment, care, and indoor shelter for my dog.

Please re-read your application before submitting to omit errors and omissions or your application will be delayed in processing.

Yes, I am aware that my adoption donation is non-refundable. My donation is a gift that keeps on giving. By taking home my dog, I have opened up space and resources for another dog to be rescued from a "High Kill Animal Shelter."

Once you hit the submit button please wait until you receive a "Thank you" pop-up on your screen. A confirmation email will be sent to you shortly.
Signature of applicant:*
Date:*
Thank you for completing our application. Your application will be reviewed by the adoption team. If approved; you will be notified via email or phone approximately 5 to 7 business days after submission. Due to the number of applications we receive; you will not be notified if your application does not meet the requirements of the rescue or does not meet the requirements of the profiles on Petfinder.Thank you for considering adopting from Greenmore Farm Animal Rescue. We look forward to working with you to find a great match for your family.
Should be Empty:

Family Members

Home / Environment / Care / General Information

Veterinary Contact Information