Apply to adopt a rescue dog

Dog you are applying for

Name of animal you are interested in adopting

Applicant information

First name

Last name

Home street address

City

State

Zip code

Home phone

Cell phone

Email

Date of birth

Driver's license number

I certify I am over 21 years old

Yes No

Employment

Use “N/A” where a question does not apply.

Employer

Employer address

Employer phone number

Household

If approved, this dog will be a member of my household. I am not applying for someone else.

I agree I am applying for someone else

Does anyone in your home smoke?

Yes No

Names of all permanent residents of your household

Ages of all permanent residents of your home, adults and children

Have you discussed this adoption with all members of your household?

Yes No Adults have discussed; kids do not know yet

If applicable, will children be taught how to play gently and kindly with this animal?

Yes No No children

Do you, or anyone in your household, have health conditions, limitations, allergies, or special needs we should consider when finding the right match?

Is anyone in your home allergic to the animal you are planning to adopt?

Yes No Yes, but tolerable and everyone is OK with it

Current pets and veterinary care

Please list any pets currently living in your home, including species, breed, name, age, sex, and whether they are altered

Are your pets:

Altered UTD on vaccines On monthly heartworm and flea/tick preventative No current pets / none of the above

Name of current veterinarian

Please call your vet and give notice that we will call. If you do not currently have a vet, we require proof of a vet appointment within one week of adopting, along with proof of heartworm preventative.

Vet address

Vet phone

Home and property

Do you live in a:

Single Family Home Duplex/Twin Condo/Townhome Trailer Apartment

Do you rent or own this property?

Rent Own

If you rent, you must provide a signed letter from your landlord or a copy of the section of your lease stating that you are allowed to have this type of animal and showing any limitations. If you live in a condo or townhome, you must show us written proof that you are allowed to have this type of animal there and show any restrictions.

Do you have a yard?

Yard, fenced with a vertical fence Yard, fenced with invisible fencing Yard, no fence No yard (apartment/condo/townhome)

Do you have a pool?

Is the pool fenced?

If your pool is not fenced, how will you ensure the safety of your adopted pet?

Care plan

Do you plan on crating your adopted dog?

How many hours per day will your dog be crated?

Do you plan on keeping your dog on heartworm preventative?

What will a typical day look like for your dog? Please be specific.

How will you exercise your adopted dog, and how often?

Where will your new pet be kept during the day?

Indoors Outdoors Crated

Where will your new pet sleep at night?

Indoors Outdoors Crated

Will your new pet be kept outdoors?

Daytime Overnight Never

How many hours a day will your new pet be left alone?

What method(s) would you use to reprimand your dog?

What plan do you have in place for your new pet if something should happen to you?

What happens if your new pet bites or nips someone?

References and final notes

Additional references, if desired

Do you have any additional comments, questions, or concerns?

Agreement and signature

By checking this box, I understand the terms of this form and adoption. I agree that I will not use this animal in any sort of fighting, breeding, or cruelty. I will love and care for this animal for the rest of its life, and I am ready to commit to that. I also agree that if I can no longer provide love and care for this animal, I will contact Salvaged Souls Pet Rescue, explain my situation, and agree to relinquish the animal back to Salvaged Souls Pet Rescue instead of taking the animal to a shelter. I understand the above and have tried, to the best of my knowledge, to make sure all information is correct.

Adopter's signature

Signature date

Adoption Application