Rescue Row Adoption Application

Rescue Row Adoption Application
Rescue Row Inc. is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. Rescue Row is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes worming, vaccinations, spaying/neutering and microchipping prior to their adoption.
This questionnaire is designed to help Rescue Row and yourself determine if a specific dog is the right one for you and your household. All adopting parties are required to complete this form prior to adoption.
Applicant Information
Name/description of the dog(s) you are interested in:*
Your full name:*
Age:*
Must be 25 or over to adopt
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*

Area CodePhone Number
E-mail:*
Employer:*
Position*
Do you have a spouse/co-applicant?*
Spouse/Co-Applicant Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Age*
Employer*
Position*
When will you be able to start a trial adoption with a dog?*
What is the primary reason you want to adopt a dog?*
Under what circumstances would you not keep this dog?*
What is the ideal personality of the dog you'd like to adopt? Check all that apply.

Running PartnerLazySocial ButterflyIndependentCuddlyActiveMellowProtector
Where will the dog be kept at night?*
Where will the dog be kept during the day?*
Do you have a dog door?*

YesNo
How many hours would the dog be left alone on a normal day?*
Please explain.*
How many weeks out of the year are you out of town?
When you are out of town, who will take care the dog?

Household Information
Number of adults living in the home?*
Adult 1 other than adoptive parent

First NameLast Name
Adult 2 other than adoptive parent

First NameLast Name
Are there children living in the home?*

YesNo
How many?*
What are their ages?*
Do other children regularly visit the home?*

YesNo
Is anyone in your household allergic to dogs?*

YesNo
Have you had experience taking care of a dog before?*

YesNo

How would you rate your level of experience with dogs?*

	1	2	3	4	5

1 is Inexperienced, 5 is Expert

What methods would be used to train/discipline the dog?*
Have you ever housetrained a dog?*

YesNo

Veterinary
Veterinary/Clinic Name:*
Veterinary/Clinic Phone Number*

Area CodePhone Number
Veterinary/Clinic Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What person's name would the vet records be under?*
As a part of the application process, a Rescue Row representative will contact your vet to verify that your pet(s) have received appropriate vet care. Have you already called ahead to give permission for your vet to release information to Rescue Row? Please note that we will contact your vet regardless of your answer. A "no" may delay the processing of your application.*

YesNoN/A
Where do you purchase heartworm preventative?*
Is any of your pet's vet care provided through TCAP or another low-cost clinic?*

YesNoN/A
If any of your pet's vet care is provided through TCAP or another low-cost vet clinic, please e-mail records of your pet's medical history to info@rescuerowinc.org.*

I understand that my application will not be processed until my pet's TCAP or low-cost clinic records have been e-mailed to info@rescuerowinc.org.
*By providing this information, you are giving permission to Rescue Row to inquire about your pet's medical history, including but not limited to: vaccination records, office visits, and test results.

Personal References
*Adoptions are based on best match, thus this application may not necessarily result in the adoption of the dog(s) listed above. Please know that Rescue Row strives to achieve the most successful match for both the dog and prospective family.
Where did you find out about the dog applying for?*
Is there anything else you would like us to know?
Signature
Potential Adopter Name:*

First NameLast Name
Potential Adopter Signature*

Clear
Date*

MonthDayYear
Date
Potential Spouse/Partner Adopter Name:

First NameLast Name
Potential Spouse/Partner Adopter Signature:

Clear
Date

MonthDayYear
Date
I understand that I assume full responsibility for the welfare of this pet from the date of adoption.
Should be Empty:

Rescue Row Adoption Application

Applicant Information

Signature