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Dog Adoption Application

Adoption

Adoption form information fields

1Applicant

2Family

3Home

4Care

5Preferences

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Default: Adopter Status
First Name*
Last Name*
Age Range*
eMail Address*
eMail Address Confirm eMail Address
Street Address*
Suite | Apt or Unit Number
City*
State/Province*
ZIP*
Country
Home Phone Number
Work Phone Number
Cell Phone Number*
- Preferred Method of Contact*
Employment & Schooling
- Are You Employed?*
  - Yes
  - No
  - Retired
- Full or Part Time?*
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  Name of Employer
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  How Long Employed There?
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  Are You in School?*
  - Yes
  - No
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  Full or Part Time?*
- How Did You Hear About Us?*
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  What Is Your Friend's Name?
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  Which Shelter?
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  Which Rescue?
- Please Describe

Below are three areas for information on other members of your family. Please include all other adults, children and pets living in your home by clicking on the designated button.
Adults
Are There Other Adults In The Home?
- Yes
- No
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How Many?*
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Adult 1
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First Name*
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Last Name*
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Age Range*
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Relationship To Applicant*
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Please Describe*
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Are They Employed?*
- Yes
- No
- Retired
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Full or Part Time?*
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Are They in School?*
- Yes
- No
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Full or Part Time?*
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Adult 2
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First Name*
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Last Name*
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Age Range*
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Relationship To Applicant*
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Please Describe*
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Are They Employed?*
- Yes
- No
- Retired
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Full or Part Time?*
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Are They in School?*
- Yes
- No
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Full or Part Time?*
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Adult 3
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First Name*
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Last Name*
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Age Range*
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Relationship To Applicant*
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Please Describe*
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Are They Employed?*
- Yes
- No
- Retired
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Full or Part Time?*
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Are They in School?*
- Yes
- No
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Full or Part Time?*
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Adult 4
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First Name*
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Last Name*
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Age Range*
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Relationship To Applicant*
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Please Describe*
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Are They Employed?*
- Yes
- No
- Retired
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Full or Part Time?*
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Are They in School?*
- Yes
- No
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Full or Part Time?*
Children
Are There Children In The Home?*
- Yes
- No
How Many?*
Child 1
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Name*
Age*
Previous Experience with Dogs:*
Child 2
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Name*
Age*
Previous Experience with Dogs:*
Child 3
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Name*
Age*
Previous Experience with Dogs:*
Child 4
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Name*
Age*
Previous Experience with Dogs:*
Dogs
Do You Now or Have You Ever Had a Dog?*
- Yes
- No
How Many?*
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Have you ever taken care of a dog before (ie dog walker, dog sitter, etc) or have any other dog experience?*
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Please Describe*
Dog 1
Dog's Name*
Where Did You Get The Dog?*
Please Explain*
Is Dog Still Living With You?*
- Yes
- No
Which Years Owned?*
How Long Did You Own Him/Her?*
Why not?*
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed*
Age Range*
Gender*
Status*
Please Explain Why Not*
Sociability*
Sleeping Quarters*
Up To Date on All Vaccines?*
- Yes
- No
Vaccinated Annually?*
- Yes
- No
Up To Date On Heartworm Prevention For Every Season?*
- Yes
- No
Is There Any Additional Information You Would Like to Add?
Dog 2
Dog's Name*
Where Did You Get The Dog?*
Please Explain*
Is Dog Still Living With You?*
- Yes
- No
Which Years Owned?*
How Long Did You Own Him/Her?*
Why not?*
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed*
Age Range*
Gender*
Status*
Please Explain Why Not*
Sociability*
Sleeping Quarters*
Up To Date on All Vaccines?*
- Yes
- No
Vaccinated Annually?*
- Yes
- No
Up To Date On Heartworm Prevention For Every Season?*
- Yes
- No
Is There Any Additional Information You Would Like to Add?
Dog 3
Dog's Name*
Where Did You Get The Dog?*
Please Explain*
Is Dog Still Living With You?*
- Yes
- No
Which Years Owned?*
How Long Did You Own Him/Her?*
Why not?*
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed*
Age Range*
Gender*
Status*
Please Explain Why Not*
Sociability*
Sleeping Quarters*
Up To Date on All Vaccines?*
- Yes
- No
Vaccinated Annually?*
- Yes
- No
Up To Date On Heartworm Prevention For Every Season?*
- Yes
- No
Is There Any Additional Information You Would Like to Add?
Dog 4
Dog's Name*
Where Did You Get The Dog?*
Please Explain*
Is Dog Still Living With You?*
- Yes
- No
Which Years Owned?*
How Long Did You Own Him/Her?*
Why not?*
Why was dog euthanized?*
Please Describe The Situation*
Please Describe The Situation*
Please Describe*
Breed*
Age Range*
Gender*
Status*
Please Explain Why Not*
Sociability*
Sleeping Quarters*
Up To Date on All Vaccines?*
- Yes
- No
Vaccinated Annually?*
- Yes
- No
Up To Date On Heartworm Prevention For Every Season?*
- Yes
- No
Is There Any Additional Information You Would Like to Add?
Other Pets
Are There Other Pets In The Home?*
- Yes
- No
How Many?*
Other Pet 1
Pet's Name*
Animal Type*
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Sleeping Quarters
Sociability
Is There Any Additional Information You Would Like to Add?
Other Pet 2
Pet's Name*
Animal Type*
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Sleeping Quarters
Sociability
Is There Any Additional Information You Would Like to Add?
Other Pet 3
Pet's Name*
Animal Type*
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Sleeping Quarters
Sociability
Is There Any Additional Information You Would Like to Add?
Other Pet 4
Pet's Name*
Animal Type*
This field is hidden when viewing the form
Sleeping Quarters
Sociability
Is There Any Additional Information You Would Like to Add?

Residence
- Type of Residence*
- Please Describe Type of Residence
- Do You Own or Rent?*
- Does Landlord Allow Dogs?*
  - Yes
  - No
- Are There Any Breed Or Size Restrictions?*
- Please Provide Landlord's Name*
- Please Provide Landlord's Phone Number*
Yard Information
Do You Have A Yard?*
- Yes
- No
Is The Yard Fenced?*
- Yes
- No
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How High Is The Fence?*
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What Material Is The Fence Made From?*
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Please Describe Fence Material*

Family & History
- What Type Of Household Do You Have?*
- Please Describe*
- Do All Family Members Want A Dog?*
  - Yes
  - No
- Please Explain Who Doesn't and Why They Don't*
- Is Any Member Of Your Household Allergic To Dogs?*
  - Yes
  - No
Are You WIlling To Take Responsibility For This Dog For The Next 10-15 Years?*
- Yes
- No
What Provisions Will You Make For The Dog Should You Become Unable To Care For Him/Her?*
- Are You Capable of Providing Timely Healthcare?*
  - Yes
  - No
- What Are You Willing/Able To Spend On Annual Vet Care?*
- Please Explain Your Circumstances*
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Feeding & Exercise
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Who Will Be Responsible For Feeding The Dog?*
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Do You Plan On Walking Your Dog Daily?*
- Yes
- No
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Who Will Be Responsible For Walking The Dog?*
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What Other Means of Exercise Do You Plan On Providing The Dog?*
Sleep & Alone Time
- Where Will The Dog Sleep?*
- Where Will The Dog Be When Alone?*
- Please Describe Where The Dog Will Be*
- What Is The Longest Time The Dog Will Be Alone (without humans)?*
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Do You Have A Doggie Door?*
- Yes
- No
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Is It Locked When You Are Away From Home?*
- Yes
- No
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If You Are Gone From Home During The Day, Does Someone Let Your Dogs Out?*
- Yes
- No
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Who Will Care For The Dog While You Are On Vacation?*
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Please Explain Who Will Care For The Dog*
Behavior & Training
Dogs Can Take A Month Or Longer To Adjust To A New Home, Particularly If Other Pets Are Involved. Are You WIlling To Devote This Much Time To Make The Dog Comfortable In Your Home?*
- Yes
- No
What Behaviors Can You Tolerate (and work on)?
Needs Social Skills*
Accidents In The House*
Inappropriate Chewing*
Excessive Barking*
Digging*
Separation Anxiety*
- Other
  - Yes
  - No
- Please Explain Other Behaviors You Cannot Tolerate*
- What Are Your Plans For Training Your New Dog?*
- Please Describe Your Training Plans*
Personal Reference
Please Provide A Personal Reference
Please Provide Reference's First Name*
Please Provide Reference's Last Name*
Please Provide Reference's Phone Number*
Please Provide Reference's eMail Address*
Relationship to Applicant*
Years Acquainted*
Veterinarian Information
Have You Used A Veterinarian Before?*
- Yes
- No
Please Provide Veterinarian's Name*
Please Provide Veterinarian's Phone Number*

Reason For Adoption
Select all that apply.
Family Companion*
- Yes
- No
Personal Protection*
- Yes
- No
For Child*
- Yes
- No
Gift*
- Yes
- No
Companion For Current Dog*
- Yes
- No
Replace A Previous Dog*
- Yes
- No
- Other*
  - Yes
  - No
- Please Describe Reason For Adoption*
Would You Consider:
Fostering While Waiting For The Perfect Dog?*
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A Dog that Has Special Needs?*
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Please Select All Special Needs(s) You Would Accept*
Select All That Apply:
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Select Gender*
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Select Age Range*
Select All That Apply
Do You Have A Preferred Dog?*
if you do not see the dogs name you’re applying for, please proceed and fill in the dogs name in the next question
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Do You Have A Preferred Dog?*
List Other Dogs You Are Interested In
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When Will You Be Ready To Adopt?*
Is There Anything Else You Would Like to Let Us Know?
I am interested in receiving pet related services and products*
- Yes
- No
Authorization
Authorization:*
I understand that all information on my Preliminary Rescue Adoption Application will be kept confidential; that my application will be kept on file until I notify Spot's Last Stop that I am no longer interested in a rescue; and that I will not be contacted unless an appropriate Dog becomes available. I understand and agree *
- I agree
Email
This field is for validation purposes and should be left unchanged.

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