Dog Adoption Application	Foster Home Application
Name of dog applying for:
Desired Gender:	Choose One Does Not Matter Male Female
Desired Age Range:	Choose One Does Not Matter Puppy: (up to 1 year) * Adolescence (1 to 3 years) Young Adult (3 to 6 years) Mature Adult (6 to 10 years) Senior (10 years +)
* Please note: We rarely have puppies available for adoption.
Will you consider a dog with more than minor medical conditions?	Choose One Yes No
Why do you want to adopt a rescue?
Personal Information
Name of Applicant:
Name of Spouse/Significant Other (if any)
Address:
Address (line 2):
City, State, Zip:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Your Age:
Your Spouse's/Significant Other's Age (if applicable)
How many other adults live in your home?
How many children live in your home?  What are their ages?
Are there any smokers this dog will be exposed to?	Select One Yes No
Residency Information
What type of home do you live in?	Select One House Townhouse/Condo Duplex/Triplex Apartment Mobile Home Other:Explain Other Home:
Do you Own or Rent?	Select One Own Rent Lease Live with Parents
If you rent, do you have permission from your landlord to keep a dog?	Select One Yes No
If you rent, please provide your landlord's name and phone number:
How long have you lived in this home?
Do you have a securely fenced yard?	Select One Yes No
What type of fence?	Select One Brick/Block Wall Privacy Wood Picket Wood Chain Link Wire Hot Wire/Tape Invisible No Fence
What is the height of your fence at the lowest point?
Do you have an in-ground pool?	Select One Yes No
If yes, is the pool fenced in?	Select One Yes No
If yes, do you have an alarm for your pool?	Select One Yes No
Do you have plans in the near future to move?	Select One Yes No
Dog Care Information
Who will be the primary caretaker of this adopted dog?
How will you exercise this adopted dog?
Where will this dog stay during the day?
Where will this dog sleep at night?
Will this adopted dog be an indoor dog or and outdoor dog?	Select One Indoors Outdoors Both
Is there an adult home during the day?	Select One Yes No
How many hours will this adopted dog be left alone each day?
Will you commit to taking this adopted dog through an obedience program, if necessary?	Select One Yes Probably Not
Will you be willing to crate train this adopted dog, if necessary?	Select One Yes Probably Not
Are you willing to take on the responsibility of this adopted dog for the next 10 years or more?	Select One Yes No
What do you think it will cost to care for this animal each year?  (Vet care, grooming, maintenance medications, licensing, etc.)
Our policy is that ALL adopted dogs must be spayed or neutered.  Do you accept this policy?	Select One Yes No
Have you ever had a pet put to sleep or die at an early age?	Select One Yes No
If yes, please explain the circumstances:
Current and Past Pet Information
Do you currently own any pets?	Select One Yes No
If yes, please provide the following details:
Type of Pet (Dog, Cat, Bird, etc) Breed Age Sex Spayed/Neutered
Have you owned any pets in the past, as an adult?	Select One Yes No
If yes, please provide the following details:
Type of Pet (Dog, Cat, Bird, etc) Breed Sex Spayed/Neutered What happened to this pet?
Do you currently have a vet?	Select One Yes No
If yes, please provide your vet's name and phone number:
May we contact your vet as a reference?	Select One Yes No
Personal References:
Please provide three (3) personal references of people that do not live with you.
Reference #1: Name:  Phone:
Reference #2: Name:  Phone:
Reference #3: Name:  Phone:
Do you have any additional comments or information that may help in consideration of approving this adoption application?
How did you hear about our Rescue Organization?
By submitting this application, I acknowledge that the information provided on this application is true and correct.