Animals in Need Rescue Society

ADOPTION APPLICATION
APPLICANTS NAME

NAME OF SPOUSE

NAME(S) OF CHILDREN IN HOME, IF APPLICABLE AGE(S)

NAME(S) OF OTHER OCCUPANTS IN HOME, IF APPLICABLE

HOME ADDRESS

CITY STATE ZIP

HOME PHONE CELL PHONE WORK PHONE OTHER PHONE

TYPE OF DWELLING? (please check) HOUSE_______APARTMENT_______ OTHER______________________ DO YOU OWN? _______ RENT? _______

IF RENTING, DO YOU HAVE YOUR LANDLORDS PERMISSION TO HAVE A DOG? YES_______NO_______

NAME OF LANDLORD PHONE

QUESTIONNAIRE
1. HOW MANY HOURS PER DAY WILL THE DOG BE LEFT ALONE? __________

2. WHERE WILL IT BE LEFT ALONE? OUTSIDE____LAUNDRY ROOM____BASEMENT____KITCHEN____BATHROOM____

MASTER BEDROOM____CRATE____OTHER, EXPLAIN_________________________________

3. WHERE WILL THE DOG SLEEP AT NIGHT? OUTSIDE____LAUNDRY ROOM____BASEMENT___KITCHEN___BATHROOM____

MASTER BEDROOM____CRATE____OTHER, EXPLAIN________________________________

4. WHAT OUTSIDE AREAS ARE AVAILABLE TO THE DOG? ____________________________________________________________________________

5. DOES ANYONE IN YOUR HOUSEHOLD HAVE ALLERGIES? YES____NO____

IF YES, EXPLAIN:______________________________________________________________________________________________________________________

6. WHAT TYPE OF EXERCISE WILL YOU PROVIDE THE DOG? SHORT WALKS____VIGOROUS WALKS____RUN/JOG____NONE____

7. HOW WOULD YOU DESCRIBE THE LEVEL OF ACTIVITY IN YOUR HOME?

LAID BACK, QUIET_______AVERAGE_______VERY ACTIVE_______CHAOTIC_______OTHER, EXPLAIN_____________________________________

8. HOW MANY TIMES PER DAY WILL THE DOG HAVE THE OPPORTUNITY TO RELIEVE ITSELF? _______

9. WHO WILL BEAR THE PRIMARY RESPONSIBILITY OF CARING FOR THE DOG? ____________________________________________________

10. HOW WOULD YOU RATE YOUR LEVEL OF DOG OWNING EXPERIENCE? BEGINNER_______INTERMEDIATE_______ADVANCED_______

11. HOW WOULD YOU DISCIPLINE THE DOG IF HE OR SHE MISBEHAVED? _____________________________________________________________

_______________________________________________________________________________________________________________________________________

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12. PLEASE LIST ALL CURRENT PETS LIVING IN THE HOME:

NAME TYPE SEX AGE ALTERED?

13. IF ANY OF YOUR ANIMALS ARE NOT ALTERED, PLEASE EXPLAIN WHY?

14. PLEASE LIST ALL OTHER PETS YOU HAVE OWNED SINCE YOU HAVE BEEN AN ADULT:

ANIMAL LENGTH OF OWNERSHIP WHAT HAPPENED TO IT?

15. ARE YOU WILLING TO LIVE WITH HAIR ON FURNITURE, STAINS ON YOUR RUGS, A WARM BODY NEXT TO YOU AND AN ANIMAL
THAT MIGHT BE DESTRUCTIVE AT TIMES? YES_____NO_____

16. WHAT TYPE OF DOG DO YOU PREFER? MALE_____FEMALE_____

17. WHAT AGE CATEGORY? UNDER 6 MONTHS_____6-12 MONTHS_____ 1-5 YEARS OLD_____OVER 5 YEARS OLD_____

18. ARE YOU PREPARED TO PROVIDE YOUR DOG WITH DAILY FOOD & ADEQUATE VET CARE ON A REGULAR BASIS? YES____NO____

19. WHO WILL CARE FOR THE DOG IF AND WHEN YOU GO ON VACATION? _________________________________________________________

20. WHY DO YOU WANT TO ADOPT? ________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________

I HEREBY CONFIRM THAT ALL STATEMENTS MADE ABOVE ARE TRUE TO THE BEST OF MY KNOWLEDGE.
SIGNATURE DATE

REVIEWED BY: DATE:

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