DOG Adoption Application-Imagine Peace for Pups

Date

MonthDayYear

Full Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Employer, phone, address

Which dog are you interested in?

Where did you hear about this dog

Please indicate reasons for wanting to adopt this dog

Do you live in a

Do you

Does your rental agreement allow pets

what are the restrictions

may we contact your landlord

If renter, name of Landlord

Phone Number

Area CodePhone Number

Do you have a secure fenced yard

How long have you resided at this address

Please check all that apply

Are there children living in the home

Ages of children

How many people are living in your home including yourself

Are all people living in your home aware you are adopting a dog

If yes, does everyone approve

Does anyone living in your home have allergies to dogs

Where will the dog be kept most of the time

If "other", please give more info

where will your dog sleep

where will your dog be when no one is home

what will he/she do for potty breaks and exercise

who will be responsible for training, exercise, and caring for the dog

how many hours will the dog be alone in a typical 24 hour day

What arrangements will you make for your dog when you are traveling

Do you currently have other pets

If so, names, ages, breeds

For current pets, check all that apply

If not spayed or neutered, please provide the reason why

Have you had any other pets in the last five years

If yes, what happened to them

Do you have any experience with the following

We don't always know what kind of training a rescue dog has. Are you committed to potty training and any other training your adopted dog may need?

Are you willing to enlist a trainer or commit to training classes with your dog if needed

Please include any other training or other experiences that you think would be beneficial when adopting one of our dogs

Please check types of confinement you can provide

Most dogs need time to adjust to new people and surroundings. How much time are you willing to allow for adjusting and bonding

Under what circumstances would you feel it necessary to give up this dog

Have you ever surrendered a dog to a shelter or Humane Society or rehomed to another person and if yes please explain

If your pet went missing, what would you do?

Have you ever been denied adoption by a rescue, please explain

Any animal violations, if yes please explain

Have you or anyone in your household ever been convicted of animal neglect or abuse or other crimes. If yes please explain

Please provide veterinarian name, phone number, and location

A home visit by one of our rescue representatives is a requirement. Do you you consent to a home visit

Please provide three references including, name, phone number,and relationship

IMPORTANT: All of the information I have provided is true and complete to the best of my knowledge. I agree to follow all rules and policies of Imagine Peace for Pups Rescue, Inc. I understand it is my decision on whether to adopt a dog or not. I will not hold Imagine Peace for Pups Rescue, Inc. responsible for any damage, injury or harm caused directly or indirectly to any person or property by any dog that I agree to adopt. Imagine Peace for Pups Rescue, Inc., at its sole discretion, reserves the right to refuse any applicant for any or no reason.

I agree that I will not make any claims against, sue or attach any property of Imagine Peace for Pups Rescue, Inc., its directors, officers, agents, employees, and/or volunteers for any injury or damage caused by any animal(s) adopted from Imagine Peace for Pups Rescue, Inc.

By submitting this application, I agree to all stated policies, releases, and wavers.

Do you agree to all terms stated above

Questions:

Signature

DOG Adoption Application Imagine Peace for Pups Rescue, Inc.