Dog Application

Canine Application

This form will not submit unless all fields are answered. Please put "N/A" if the question does not apply to you.
Your current email address for our response
Your Email Address:
Which Dog are you applying for?
What is the dog's name?
Applicant		Co-Applicant
Full Name:		Full Name:
Relation to Co-Applicant?		Relation to Applicant?
Age:		Age:
Street Address:		Street Address:
Town/City:		Town/City:
State:		State:
Zip Code:		Zip Code:
Home Phone:		Home Phone:
Cell Phone:		Cell Phone:
Place of Employment:		Place of Employment:
Nature of Employment:		Nature of Employment:
Work Phone Number:		Work Phone Number:
# of hours worked per day:		# of hours worked per day:
Tell Us About Yourself

1. How did you hear about us?

If "other" please explain:

2. Which one of these do you live in?

3. Do you Own or Rent?

4. What is the apt. name, phone number, landlord’s name and pet deposit fee of the complex?

5. Do you have the landlord’s permission to own pets?

Yes No

6. If so what is the deposit required?

7. How long have you lived at your current address?

8. Does anyone in your home have pet allergies?

Yes No

9. Have you ever been involved or are you currently involved in breeding animals?

Yes No

10. Will this Dog be a surprise for anyone in the house?

Yes No

11. If you move to an apartment or rental that does not allow pets, what will you do?

12.Do you have a fenced in yard with no gaps, holes, or needed repair?

Yes No

13. How high is your fence?

14. Is the fence wood, metal, or vinyl?

15. Do any of you pets live mostly outdoors?

Yes No

16. Are your pets spayed or neutered?

Yes No

17. For which of the following reasons would you consider giving up your dog? (check all that apply)

Moving		Not Housebroken
Divorce		Fights with other pets
Excessive Barking		Gets too large
Kids no longer want it		Medical Issues
Jumps Fence		Behavior Issues
New Baby		Allergies
Financial Problems		Messes up furniture

18. Have you ever given up a pet? If so please explain the circumstances.

Yes No

If so please explain...

19. Please tell us who your current veterinarian is as well as their address and phone number.

Name:
Address:
Phone:

20. What are your pet’s names and species? (So we can ask for records at your vet)

21. Has a cat on your premises ever died of FIV, Feline-leukemia, or unknown causes? ...a Dog of Parvo or Distemper?

Yes No

22. If you date or marry someone who does not want you to keep your pet what will you do?

23. Have you looked at or applied for an animal with another rescue group? If so did you adopt? Why or Why not?

24. Do you object to a home visit from a member of our organization?

Yes No

25. Where will your new dog stay during the day?

26. Please list previous animal’s you have owned and where they are now.

27. Do you think having ID on your Dog at all times is a good idea? If not then why?

Yes No

28. How much time are you willing to give your new dog to adjust to its new home?

29. Where will the dog go when you leave town?

30. Are your pets current on their vaccinations and shots and can we call your vet to check?

Yes No

31. Please list the names and phone number of two personal references:

Reference1

Reference2

Please read the legal section carefully and enter your name below.

For and in consideration of The Dog House Rescue and Adoption, Inc. (the "Dog House Rescue and Adoption") allowing you to adopt one of its animals, the receipt and sufficiency of which is hereby acknowledged, you agree as follows:

In signing this adoption agreement, you agree to provide a loving, safe and caring home for your new companion. You acknowledge that you have been fully informed to the best of your and The Dog House Rescue and Adoption, Inc. staff's knowledge, about any history, medical problems or treatments, and/or behavioral problems or issues associated with your new companion. Upon full disclosure of this information, you hereby exempt The Dog House Rescue and Adoption, Inc. and its staff or representatives from all legal damages which may be associated with such information.

You agree to allow a representative of The Dog House Rescue and Adoption, Inc. to telephone and/or visit you and your new companion. (Yes, you can even send us an occasional snapshot!) All Dog House Dogs must be kept on monthly heartworm/flea prevention and receive routine veterinary care.

If you are adopting an animal too young to be spayed or neutered, you agree to spay/neuter your companion BY THE TIME IT IS SIX MONTHS OF AGE, and you agree to notify or have your vet notify The Dog House Rescue and Adoption, Inc. when you have done so. YOU AGREE NOT TO BREED THIS ANIMAL UNDER ANY CIRCUMSTANCES. The Dog House Rescue and Adoption will not tolerate one of our rescues being put out on chains or tie outs. A backyard is a must to take home one of our dogs. We reserve the right to reclaim any animal who is not in a fenced yard. The Dog House Rescue does not allow the De-clawing of Cats. By signing this contract, you have agreed not to de-claw the adopted cat. The Dog House Rescue and Adoption reserves the right to reclaim any cat that has been de-clawed. There are humane training techniques that an owner can use if needed.

Further, in signing this form, you agree that if at any time in the future, for any reason you can no longer keep and/or care for your companion properly, you will contact The Dog House Rescue and Adoption, Inc. or one of its representatives (Amelia) immediately. At that time, The Dog House Rescue and Adoption, Inc. will take back your companion at no cost to you, and provide shelter and care until a new home can be found. You agree not to euthanize this animal for any reason without first notifying The Dog House Rescue and Adoption, Inc. In the event of accidental death of this animal, you agree to first notify The Dog House Rescue and Adoption, Inc. or its representative(s) immediately.

You understand that if this application contains any false or misleading information, The Dog House Rescue and Adoption, Inc. is entitled to reclaim your companion at any time. If in its discretion, the Dog House Rescue and Adoption determines that an animal is being abused, abandoned, or not otherwise properly cared for; it reserves the right to reclaim the animal. You agree that the Dog House Rescue and Adoption is not required to refund any adoption fees or pay you any other money for an animal that it reclaims. The Dog House Rescue and Adoption Inc. reserve the right to deny an adoption application for any reason. The Dog House Rescue will prosecute for any abuse or abandonment of one of our animals.

Pre-adoption veterinary requirements will be taken care of by The Dog House Rescue and Adoption-Puppies/Kittens come with first/second set of vaccines, continuation of veterinary care is the responsibility of the adaptor(s) and is necessary for the continued health of your new pet.

Although an animal is always welcome back if a complication arises after an adoption all fees are non-refundable.

By entering your name below you are entering into a binding agreement between yourself and The Dog House Rescue & Adoption Inc. and are in agreement that all information on this form has been filled out correctly and honestly to the best of your knowledge.

Please choose only one of the answers below for each statement.

I am aware that my new dog must be returned to The Dog House Rescue & Adoption in the event I can no longer care for it.