CANINE ADOPTION APPLICATION

Name:
Address:
City/Town:
Province/State:
Postal/Zip Code:
Telephone - Day and Evening:
Email Address:
Type of Dwelling:   
Other:

Do you:  
If you rent, do you have your landlord's permission?
Yes
No
Landlord's Name and Telephone Number:
How long have you lived at this address?
If less than 3 years, please list your previous addresses (for the last three years).
Your occupation?
Who would be the dogs primary caregiver?
Do you have a fenced yard?
Yes
No
If yes, what type and height of fence?
Does this fencing completely enclose a yard for a dog?
Yes
No
How many adults live in the household?
How many children live in the household? What age(s) and gender(s)?
Is there anyone in the house who is not sure about getting a dog?
Yes
No
If yes, who, and why?
Please select which of the following describes what you are looking for in a dog.
Small (less than 25 lbs)

Medium (25-50 lbs)

Large (over 50 lbs)
Please select which of the following describes what you are looking for:
Puppy, less than six months
 
Puppy, less than a year
 
Young adult, 1-3 years
 
Mature dog, at least 2 yrs
 
Mature dog, at least 5 yrs
 
Senior dog, 8 yrs or older
 
No age preference
 
Depends on the dog
Gender Preference:
Male
 
Female
 
No preference
Appearance:
Short hair
 
Medium hair
 
Long hair
 
No preference
Disposition of dog (pick all that apply):

Active dog -  herding breed preferred
 
Any active dog

Moderately active dog

Minimally active dog

No activity lever preference

Good with kids
 
Good with dogs
 
Good with cats
 
Good with horses/livestock
 
House trained
 
Crate trained
 
Obedience trained
 
Good in car

Are there any particular breeds that you prefer?
Why do you like this breed?
Have you had a dog of this breed before?
Yes
No
Is there a particular dog(s) that you are interested in?
Which of the following describe what you are looking for in a dog (pick which apply)?
Agility/Flyball
 
Breeding
 
Companion
 
Family dog
 
Friend
 
Gift
 
Guard dog
 
Helper
 
Member of the family
 
Pet
 
Search and Rescue
 
Therapy dog
 
Working dog
Other:
Please list your current pets, including species, breed, age and sex of each:
Please list all pets you have owned in the last 10 years, and what happened to each:
Are your pets spayed/neutered?
Yes
No
Have any of your pets ever had puppies/kittens?
Yes
No
Veterinarian name and Telephone number:
If requested, would you be willing to crate your dog?
Yes
No
If requested, would you be willing to enroll in an obedience class?
Yes
No
Where would the dog spend the day?
Backyard
 
Basement
 
Crated in house
 
Doggie daycare
 
Garage
 
Indoor kennel/run
 
In house, restricted rooms
 
Loose in house
 
Loose outside
 
Outdoor kennel/run
 
Tied up outside
 
Will accompany me to work
 
With friend/relative
Other:
Where would the dog spend the night?
Backyard
 
Basement
 
Crated in house
 
Doggie daycare
 
Garage
 
Indoor kennel/run
 
In house, restricted rooms
 
Loose in house
 
Loose outside
 
Outdoor kennel/run
 
Tied up outside
 
Will accompany me to work
 
With friend/relative
Other:
How many hours daily would the dog be left alone?
How often do you go on holidays or take vacations?
Where would the dog stay while you are on vacation?
What would you do with the dog if you moved somewhere that did not allow pets?
What are your plans regarding exercising the dog and toilet duties?
Please provide the names, occupations, and telephone numbers of two references, 
and indicate your relationship to them:
Please add any additional comments here:
Where did you hear about ANML-RESQ?

I AGREE THAT BY SUBMITTING THIS APPLICATION, I UNDERSTAND THAT COMPLETING THIS APPLICATION DOES NOT GUARANTEE THAT ANY ANIMAL(S) WILL BE ADOPTED TO ME. I ALSO CERTIFY THAT I HAVE BEEN WHOLLY AND COMPLETELY TRUTHFUL AND HAVE NOT CONCEALED OR WITHHELD ANY INFORMATION. 

I HEREBY AUTHORIZE ANML-RESQ TO VERIFY ANY INFORMATION GIVEN BY ME AND/OR TO INVESTIGATE MY APPLICATION HOWEVER THEY SEE FIT. I UNDERSTAND THAT ANML-RESQ IS A RESCUE AND REHOMING PROGRAM AND NOT A REFERRAL SERVICE.


Yes
No
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