adoption application - Critters in Need Pet Rescue by sofiaie


									                    Critters in Need Pet Rescue
                             DOG ADOPTION APPLICATION

28206 Via Alfonse                                             Date______________
Laguna Niguel, CA 92677
Fax: 714-530-3963

Thank you for taking the time to complete this application. Completion of this application does not
guarantee the adoption of an animal. Please be sure to answer each question, giving as much
detail as possible, providing contact people and phone numbers when requested. All dogs are
spayed or neutered, current on vaccinations and micro-chipped prior to adoption. Additionally, the
dogs have received whatever veterinary care required making them adoptable.

In which dog are you interested? ______________________________________________

Why are you interested in this particular dog? ____________________________________

Name of Applicant: ________________________________________________________

Street: ____________________________________

City: ____________________________________ State: ____ Zip: __________

Home Phone (include area code): _________________________

Cell Phone (include area code): ___________________________

Work Phone (including area code): ________________________

Email: ________________________________________________

Name of Spouse or partner:     _______________________________________________

If this relationship were to change, who would keep the pet? _______________________

If you have children, what are their ages? _______________________________________

Please list any additional people in the household ________________________________


Occupation: __________________________________________

Employer: __________________________________________________________________

Do you live in a?    House / Apartment / Condo / Other ____________________________

Do you: Own / Rent

If renting, do you have your landlord’s permission to have a dog?         Yes / No
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Landlords or HOA Assoc. Name & Phone Number:

How long have you lived at this address?

If you are in an Apt or Condo, what is the pet weight limit? ______________

Will the dog be an indoor or outdoor pet? __________________

How many hours will this dog be inside? __________________

How many hours will this dog be outside? __________________

How long will the dog be left alone each day? _______________

Where will the dog be left when alone? ____________________

Will the dog be allowed on the furniture?   Yes / No

Will the dog be allowed in all areas of the house? Yes / No

Which areas will be off limits? __________________________________________________


Where will the dog sleep at night? ______________________________________________

What brand of dog food will you feed your dog? __________________________________

Will you give your dog people food? Yes / No

What type of exercise will you provide? _________________________________________


Will you walk/exercise this dog on or off leash (or both)?

If off leash, where?

Do you have a backyard? Yes / No

Is your backyard fenced? Yes / No

Height of fence _________ Type of fence ___________ Latched or locked Gates? _____

Do you have a pool?      Yes / No

If yes, is it fenced?   Yes / No

Will this be your first dog?   Yes / No

Please list any pets that you currently have in your household:

Are ALL other pets spayed or neutered? Yes / No

If you have cats, are they indoor or outdoor? Indoor / Outdoor

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If you have a cat/s are they declawed?     Yes / No

If the cat/s are declawed, please explain why:

Please list pets you currently have and have had in the past:

Pet #1 Breed

Male or Female

Length of Ownership?

Still own?   Yes / No

If yes, how old is this pet?

If not, what happened to this pet?

Pet #2 Breed

Male or Female

Length of Ownership?

Still own?   Yes / No

If yes, how old is this pet?

If not, what happened to this pet?

Pet #3 Breed

Male or Female

Length of Ownership?

Still own?   Yes / No

If yes, how old is this pet?

If not, what happened to this pet?

Have you ever been in a situation where you were not able to keep a pet?

If you have given a pet away before, please explain:

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Were you ever in a situation where you had to bring a dog to a shelter?

If yes, please explain:

Do you travel often?

Who will take care of the dog when you go out of town?

Who would you give the dog to if you move?

Please list two personal references that we may contact:

Name: ________________________________________________________

Street: ____________________________________

City: ____________________________________ State: ____ Zip: __________

Home Phone (include area code): _________________________

Cell Phone (include area code): ___________________________

Name ________________________________________________________


City____________________________________ State____ Zip__________

Home Phone (include area code): _________________________

Cell Phone (include area code): ___________________________

Who is your Veterinarian?

City _______________________________ State _____ Zip __________

Phone: __________________________________________

Are you aware of the costs involved with veterinary health care and are you willing to take
on the necessary financial responsibility in the case of an accident or illness?

Are you aware of low-cost health insurance for your pet?

Would you get pet insurance for your new pet?

If there a medical emergency occurs with your new pet, would you be able to cover the
average cost of $350?

If no, who would?

What is a reasonable amount to spend on your dog if he became very sick?
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Does anyone in the home have allergies?      Yes / No

If yes, who?

What would happen if someone in the home developed allergies related to the new dog?

How will you train this dog? Obedience School / Spray Bottle / Firm Verbal Commands /
Other? Please explain:

Are you willing to housebreak a dog?

If yes, using what method?

What will you do if the dog has potty accidents in your house?

Do you understand and accept that a change in a dog's environment may cause the dog to
have accidents, especially in the early days of the adoption? Yes / No

What will you do if the dog chews, digs or has other bad habits? Please give examples.

Do you plan to take your new dog to obedience school? Yes / No

If you answered no, please explain why:

Are you prepared and able to take care of this dog for his/her entire lifetime?

Do you have a friend or relative who would take this dog if you became unable to care for

If yes, please list name and phone number and relationship:

Are you aware of the annual costs of premium dog food, toys, vet care, grooming, etc. for
your new pet?

What circumstances would cause you to give up a pet?

If you become unable to keep this dog, would you return it to Critters in Need Pet Rescue?

We reserve the right to inspect all potential homes and yards prior to placement and make
home visitations at later dates.

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Is this agreeable to you?   Yes / No

We are a non-profit organization. The adoption donation is used to partially recover the
costs involved in rescuing this dog. These costs include, but are not limited to: shelter
fees, spay/neuter, food, housing, vaccinations, de-worming, microchip and any vet exams
or medical care that the dog may have required. We would not have been able to save the
life of the dog you applied for without the adoption donation from another that came
before him/her.

Are you willing and able to make the adoption donation?

I have read the above information carefully and have filled out this application honestly. I
understand that omission of information and/or failure to answer all questions can result
in the application being declined. Also, if an omission or untruth is discovered after an
adoption takes place, I understand and accept that Critters in Need Pet Rescue has the
right to annul the adoption and reclaim the dog. This application becomes a part of our
Adoption Contract.

Printed Name: __________________________ Signature:____________________________

Date: ____________________________

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