Please answer all the questions marked with a red asterisk or the form will not get sent. Type N/A if the question is not applicable. We will get back to you quickly. Thank you for applying.

About You

Adopter's Full Name *

First Name Last Name

Adopter's Date of Birth *

Date

Co-Adopter's Full Name

First Name Last Name

Co-Adopter's Date of Birth

Date

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Email *

example@example.com

Preferred Phone Number *

Area Code Phone Number

Secondary Phone Number

Area Code Phone Number

Place of Employment / How Long Employed *

How many people live in your home? *

.If there are children in your household, how many and what are their ages? Please Note: Sorry, but we do not adopt dogs into homes with children under the age of 10. *

About Your New Dog

Name of dog for which you are applying? *

Why do you want to adopt a dog? *

What do you think are the most important responsibilities in owning a dog? *

Please list any preferences (age, gender, breed, personality). *

Type N/A if you have no preferences.

Have you submitted an application with another organization for a dog at this time? *

Yes No

Have you ever had an application declined for adoption of an animal from a welfare group or animal control facility? If yes, please explain. *

Are you willing to take the time to housetrain a dog and do you understand that changing a dog's environment may cause the dog to have accidents until it is used to it's new home's environment and schedule? *

Yes No

If you are applying for a puppy / dog who is not housetrained, how will you housetrain the dog? *

Type N/A if not applicable.

Does any member of the family have any allergies to animals? If so, please explain. *

Describe the kinds of personal situations where you might have to return your adopted dog (i.e., job loss, children, move, marital change, etc.) *

Type N/A if not applicable.

For whom are you adopting the dog? *

Self Gift Other family member

Who will be responsible for feeding and taking the dog outside? *

Who will take care of the dog in the absence of the primary caretaker? *

What reading or other steps have you taken to prepare for a new dog? *

Will you take obedience training? *

Yes No

Will you be willing to obtain an appropriately sized open wire crate, if recommended? *

Yes No

Have you considered the extra expense that will come from having a dog,including vet care, dental care, food, shelter? *

Yes No

Have ALL ADULT family members agreed upon a new dog?

Yes No

About Other Pets in Your Household

Describe those pets you currently own (Name, Type, Age, Gender) *

Type N/A if you have no other pet.

When and where did you get your current pets?

Type N/A if you have no other pet.

Are all your pets spayed or neutered? *

Yes No

What brand of Heartworm preventative and flea/parasite control do you use? *

Type N/A if you currently have no pet.

What brand(s) or types of food do you provide on what kind of schedule? *

Type N/A if you currently have no pet.

Are your pets primarily indoor or outdoor? Explain. *

Type N/A if you currently have no pet.

Any previous pets? *

List all pets you previously owned in the past 10 years (Name, Type, How Long You Had the Pet, Cause of Death). Type N/A if none.

About Your Vet

What kind of veterinary care do you plan to provide? *

Will you put your new pet on a health care veterinary plan? *

Yes No

Name of veterinarian you will use for your new pet? *

Veterinarian Phone Number

Area Code Phone Number

List each veterinarian where your animal(s) received care over the last 10 years. *

Vet name, phone number, date of last vet visit, owner name under which records are listed. Please note that the application review cannot be completed unless each vet's phone number is provided. Type N/A if you had no pet over the last 10 years.

About Your Home and Dog's Safety

Do you own or rent your residence? *

Own Rent

If you rent, list your landlord's name and phone number. *

Type N/A if you don't rent.

If you rent, what type / size of pets are allowed?

If you rented your current residence for under a year, please provide prior address and prior landlord's name and phone number. *

Type N/A if you didn't rent for under a year.

Do you have a fenced yard? *

Yes No

Describe the circumstances in which you would walk / exercise a dog on leash? *

How often will you exercise the dog and for approximately how long? *

How many hours will the dog be left unattended (i.e., work day)? *

Where will the dog sleep? *

How often do you travel? *

When you are not home for a long period of time (i.e., vacation, trip), where will the dog be kept? *

When no one is at home (i.e., work, shopping), where will the dog stay? Please be specific. *

Have you used or plan to install a dog door? *

Yes No

If you move, what will you do with the dog? *

Are you or your spouse with the military? *

Yes No

Are you aware that Rescue requires all dogs/cats in a home be spayed or neutered? *

Yes No

List 3 NON-RELATIVES for references (include email addresses and phone numbers)

Our adoption fee / donations varies for each dog and we usually include it in the dog's description. We try to recover the money we spend on the dog for veterinary exams, immunizations, spaying/neutering, Heartworm tests, flea/tick control, food, grooming, etc. Most of the time we have to pay shelter fees for the dog we rescue and sometimes we incur expenses in having the dog transported to his/her foster home.

Some dogs come to us with medical problems which need to be addressed before they can be adopted. We are not in this for the money and we will always ask a fair price for each of our dogs. If adopters require a dog to be professionally groomed before transfer to them this cos,t will be in addition to the adoption/donation fee and typically runs around $50 - $60 per dog.

I HAVE READ THE ABOVE INFORMATION CAREFULLY AND HAVE FILLED OUT THIS APPLICATION HONESTLY. I UNDERSTAND THAT THE OMISSION OF INFORMATION AND/OR FAILURE TO ANSWER ALL QUESTIONS AND SIGN THE APPLICATION CAN RESULT IN THIS APPLICATION BEING DECLINED. I GIVE SOMERSET COTTAGE POODLE RESCUE PERMISSION TO FULLY INVESTIGATE THE INFORMATION PROVIDED AS WELL AS CONTACT VETERINARIANS AND RELATED OFFICIALS. IF THE APPLICATION PASSES THIS REVIEW, I AGREE TO A HOME AND YARD VISIT ON A MUTUALLY AGREED DATE BY A VOLUNTEER BEFORE AN ADOPTION DECISION IS MADE.

Adopter's Signature *

Please type your full name.

Today's Date *

Date

If you have any questions, please email Somerset Cottage Poodle Rescue.

Before you hit Submit, please make sure all the blanks are filled in, even if you have to type N/A for "not applicable."

* indicates required fields.

Adoption Application

About You