Dog Adoption Application

Pitties and Pals Rescue Dog Adoption Application
Name of the dog you want to adopt *
If your preferred dog is not available, would you be open to adopting another dog?

Yes No
Adopter's Name *
First & Last Name
Co-Adopter's Name
First & Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Adopter's E-mail *
Co-Adopter's E-mail *
Phone Number *

Area Code Phone Number
Co-Adopter's Phone Number *

Area Code Phone Number
Names and ages of all permanent residents of your home (adults/children) Must be 21 years of age in order to adopt. *
Adopter’s Occupation & Employer *
Co-Adopters Occupation & Employer
Current pets in your home *
Previous pets in your home. If no previous pets, please describe any experience you've had with dogs *
Facebook name
Instagram name
Vet reference (please call your vet and give permission to release information to us) *
Vet name, address & phone number
When will you be ready to adopt this dog? *

Today This weekend Within a week Within a month Not ready yet, just researching
Is anyone in your home allergic to dogs? *

Yes No
Does anyone in your home fear dogs? *

Yes No
I/We live in a *

Single Family Home Duplex/Twin Condo/Townhome Trailer Apartment
Do you rent or own this property? *

Rent Own
Please submit a copy of your pet policy as per your rental agreement to pittiesandpalsrescue@yahoo.com once you submit your application.
Do you have a yard? *

Yard, fenced with a vertical fence Yard, fenced with invisible fencing Yard, no fence No yard (apartment/condo/townhome)
If fenced, fence height is:

2' high 3' high 4' high 5' high 6' high
Do you work outside the home? *

Yes No One applicant is home/works from home
If you both work outside the home, how many hours per day are you away? *
Have you discussed this adoption with all members of your household? *

Yes No Yes, adults have discussed. Kids don't know yet.
Please check all that apply. I want to adopt this dog... *

As a family pet To train/use for hunting To train/use for agility To train/use as a therapy dog To train/use as an assistance dog for the disabled For a jogging/hiking partner To interact with lots of friends/family As a companion for my dog(s) As a companion for my cat(s) As a companion for my child/children
Have you ever returned, given away, relinquished ownership or euthanized a dog? Please explain in detail for each instance. *
What would cause you to return a dog? *
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family? *
How do you plan to integrate this dog into your family? *
Name and Phone Number of a Personal Reference *
How to you hear about our rescue? *

Facebook Instagram PetFinder Rescue Me Adopt a Pet Our Website Referral
I certify the above information is true and correct to the best of my knowledge. I also acknowledge falsification of the above can result in my being denied adoption of an animal or, if an animal has been adopted to me, the return of that animal to Pitties and Rescue. I understand all animals adopted from Pitties and Pals Rescue will be spayed/neutered before adoption. Pitties and Pals Rescue, Inc. isn’t responsible for any damage or injury caused by an animal. Please read the above, check this box, sign, and click Submit.

I/We have read and understand all of the above.
Applicant's Signature *
Co-Applicant's Signature
Signature date *
Should be Empty:

Pitties and Pals Rescue Dog Adoption Application