What is the name of the dog you are interested in adopting?
Your Name:
Home Address:
City, State, Zip:
Home Phone:
Cell Phone (If none, enter NONE):
Work Phone (If none, enter NONE):
May we call you at work?
Email Address:
Are you the Head of Household?*

*If not, head of household must fill out the application or we will not consider it even if you are of an adult age living in the home.

Please list ALL of the animals (dogs, cats and rabbits) you have had in the past 5 years and that you currently own. Failing to include an animal will void a potential adoption.

TYPE/BREED SEX AGE SPAYED-NEUTERED WHERE IS THIS PET NOW?

Please use the Comments Section at the bottom to list any additional Pets.

If you have not had any animals in the past five years, please detail your experience with animals whether as a child or in your lifetime. What breed(s) of dog you have owned and for how long you have had that dog.

Why do you want to adopt this dog? (Please check all that apply)

Companion Guard Dog Gift For Children Family Companion

 

How many adults are in your household?
What are the ages of the adults?

Please explain the relationship of the people in the home (roommates, significant others, mom, dad, children, etc.) and which member of the home you are in this household.

How many children are in your household?  (If none, enter NONE)
What are the ages of the children? (If none, enter NONE)
If there are no children do you expect that to change in this pet’s lifetime?
Has every member of your family agreed to this adoption?*

*If this has not been discussed at great length, please complete application when that has occurred.

Do you have a planned vacation in the next month?
Are you prepared to adopt immediately and take your pet home?* If not, when? When?

*If not, within the next 7 days, please complete application when you are prepared to do so.

Does any member of your family have allergies or asthma?
If Yes, Please Describe:
Is someone home during the day?
If Yes, WHO?
How many hours a day will this pet be alone during the day?
When I am home this pet will be kept:
When I am not home this pet will be kept:
Where will this pet sleep?
What type of home do you live in?   Describe other:
Do you Own or Rent?   Describe other:
If you rent, do you have permission to have pets?
If you rent, please provide your Landlord's Name and Phone Number:
If you move (locally, out of state, or out of the country) what will you do with this pet?
Do you plan to take this dog to obedience classes?   If Yes, Where?
Have you ever taken a dog to obedience classes?   If Yes, Where?
Do you have a securely fenced yard?
What type of fence?
What is the height of your fence at the lowest point?
Do you have a pool?
If Yes, is the pool gated?
Who will be the vet for this pet? (Name and Phone Number)

Which reasons are acceptable reasons for giving up your pet (s) (Please check all that apply)

  Fence Jumping   Allergies
  Moving   Housebreaking Accidents
  Illness   Spraying
  Biting   Showing Teeth
  Chewing   Too Active
  Stealing Food   Scratching
  Growling   Hides for a week
  Puppy   Compatibility issues with other pets
  Destructiveness  
If you did not mark any reasons, why not?
Are you willing to housebreak a dog?

How will you deal with the following issues? Please do not write training. We are looking for specific ways you will deal with these issues. Please be thorough.

Chewing:
Digging:
Barking:
Housebreaking:

Please tell us why this dog is a good match for your family and why you are interested in this particular dog. Please tell us how this dog will fit into your lifestyle and what your expectations or hopes are for adding this dog to your family. Please note that this may be the most important part of the application and in our determining that you're the right match for this dog. Please add any information that you believe is pertinent to our making this decision.

Have you ever had to give up a pet?
If YES, please explain: When?   Why?
If your pet gets sick what will you do?
You will probably get a follow-up call, e-mail, or a home visit from a DPS Rescue Volunteer to make sure everything is going well with your new pet.    Will this be a problem?

Do you have any questions or additional comments?

How did you find out about DPS Rescue? (please check one)

  PetSmart   Petfinder   Adopt-a-Pet
  Other: Describe:  

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