Rescued Friends, Inc.

Canine Adoption Application

Animal you are interested in: __________________________________________

1. Are you 18 years or older? Yes No

2. Your Full Name: ____________________________________________________________

Street Address: _____________________________________________________________

City, State, Zip: _____________________________________________________________

Home Phone: __________________________ Cell Phone:

__________________________

3. How long have you lived at the above address? __________

4. Are you planning to move in the next 6 months? Yes No

5. Do you own or rent your home? Own Rent

6. If you rent, does your landlord allow pets? Yes No

7. Name and phone number of landlord:

____________________________________________

8. Where will the animal stay when you are not home?

Loose inside ____________ Loose outside ______________

Crated or otherwise restrained inside _____________ Kennel run _______

Fenced yard __________ Tied/chained outside _________

Other (describe) ________________________________________________

9. If you have a fence, what type? Chain-link wooden barbed wire hog-
wire

10.If you have a fence, how high is it? 3 ft 4 ft 6 ft 8 ft

11.Is this pet for YOUR household? Yes No if not, is it a gift? Yes No

12.How many people live in the adopting household? ____________

13.Do you have children? Yes No If so, what are the ages?
_________________

14.If not, do children visit the home often? Yes No

15.Do you own other dogs or cats? Yes No

16.If yes, please describe the breed, sex, and age of each.

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 Breed Size Age Sex Spayed/Neuter
ed
Yes No
Yes No
Yes No
Yes No

17.If not fixed, why not? _______________________________________________________

18.Are they current on yearly vaccinations? Yes No

19.Are they currently on heartworm prevention? Yes No

20.Does your city, subdivision, landlord have any restrictions on the number of
pets you can own? Yes No if so, what is the
limit? __________

21.How many cats and dogs have you owned in the last 5 years? Dogs _____
Cats _____ What happened to them?
________________________________________________________
________________________________________________________________________

22.Your veterinarian’s name and phone number:

_____________________________________

23.If no vet history is available, do you give permission for home visit(s) and/or
follow-up inquiries? Yes No

24.Since most rescued animals have unknown medical histories, are you
prepared to pay for necessary medical treatments? Yes No
Animals can be expensive to care for (estimated average cost is $750 for a
dog in one year) Are you willing and able to provide adequate food, water,
shelter, and medical care, including yearly check-ups, vaccinations, and
heartworm preventative for an adopted animal? Yes No

25.How many hours will the animal spend alone? _______ Where will it stay when
it is alone? ___________________________ Where will it stay during the day?
____________________ Where will it stay at night?
___________________________________________

26.What problems would make you return the animal? Barking housetraining
chewing jumping shyness shedding digging other – explain
______________________________

27.To help resolve these problems, are you willing to:

use a crate take an obedience class do nothing

28.Check the traits that are most important to you in a pet:

Good with children Low energy

Good with dogs High energy

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 Good with cats Won’t need obedience
training
Travels well Doesn’t chew, dig or jump
Coat length Will run with jogger owner
Purebred Appearance

29.Under what other possible circumstances would you return the animal? move
new baby divorce high cost of animal care personal illness other –
explain _________________

30.Do you agree to return the animal to Rescued Friends, Inc. if at any time
during its life, you find yourself unable to keep it? Yes No

31.Are you willing to sign a legally binding Sterilization (Spay/Neuter) Contract?

Yes No

I represent that the information I have provided on this form is the truth to the best
of my knowledge and belief. Any falsification or omission of any of the above
information will result in automatic refusal of adoption or confiscation of the
adopted animal. Rescued Friends, Inc. has the right to deny the adoption of any pet
for any reason. You understand that our objective is to assure the safety and
welfare of these animals. We will contact you if your application is approved.

Applicant: _____________________________________________________ Date:

________________

Rescued Friends, Inc. Adoption Application Page 3