Small Breed Dog Rescue

Adoption Application
Please cut and paste this into a word or text document or email, complete it, and email back to us.
Note - it is not our intention to invade your privacy, but merely to be sure that the dog you select is the best fit for your family.

Date: ________________

Name: ________________________________________________

E-mail Address: ________________________________________

Address: ______________________________________________

_______________________________________________________

Home Phone #: (_______)______________________

Work#(_______)______________________________

Cell #(_______)_______________________________

Name of the dog(s) you are interested in: _________________________

If you don’t see a specific dog you like, we will do our best to match your request with new arrivals.

Are there any breeds you prefer? ____________________ Are mixes ok? ____________

What age of a dog would you like to adopt? ____________________________________

Would you like to adopt a male or a female? (note that all dogs will be altered) ________

Do you have any personality preferences? (high energy, low key, good with kids, etc…) ________________________________________________________________________

Who lives in the household.  Ages of children, number of adults.

 ________________________________________________________________________

Do other kids visit your home on regular basis?  ________________________________

Who will be responsible for the care of the dog? ________________________________

Do you rent or own your residence? _________________

If rent, please provide landlord phone number: __________________________________

Do you have a yard? (a yard is not a requirement for most dogs) ____________________

Is your yard fenced?  ________    How high? ________________________________

Do you have a pool? ___________________

Does anyone in your home have pet allergies? __________________________________

Where will the dog primarily stay (house, yard, kennel, a room, etc)? ________________

________________________________________________________________________

Where will the dog sleep at night (crate, doghouse, owners’ bed, couch, own bed, etc…? ________________________________________________________________________
On average how many hours a day will the dog be left alone? _____________________

Where would the dog stay while alone (house, kennel, yard, etc…)?_________________ ________________________________________________________________________

Current pets:

What is the name and phone number of your current veterinarian? _______________________________________________ ________________________

Previous pets:

Have you ever had to give up an animal for any reason?  ________

If so, what was the reason? _________________________________________________

What would happen to this pet if you were to move? _____________________________

Are you planning on taking this dog to obedience classes? _________________________

Would you object to a home visit by one of the volunteers? ________________________

Is there anything you would like to add?

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