Adoption Application

This questionnaire is intended to help us in making the best match possible.  Please be detailed in your answers as it will give us a better picture of you and the home you will be providing. 

Name and Address:
City	State	Zip

Email

Telephone (specify if day or evening calls preferred)

How long have you lived at this address? 

Do you:  Own, Rent, Live with Relatives? 

Do you intend to move soon? 

Landlord's name		Landlord's phone number
May we contact the landlord for a recommendation?  Yes  No

If you are looking at a specific puppy/dog from our WEB site, please indicate which one.  If you are not looking at a specific one indicate if there are specific characteristics (color, size, sex) you want.  Indicate why you are interested in this particular dog.

If you have ever owned a pet before describe the experience. 

Describe the home you will be giving your new pet.  Indicate if you are in a house or apartment and if you have an enclosed yard or nearby open space for play (such as a park).  Will this dog be an indoor or outdoor pet?

Explain what being a caretaker of a pet means to you. 

Indicate the length of time this pet might be left alone. Include the surroundings that the pet will be left in while you are gone (eg. outside in fenced back yard, kenneled, run of the house, other).  If your yard is fenced is it secure enough for a small dog.
 

Tell me about other family members in the home, children, parents, etc., be sure to indicate ages of children and some family activities (eg.  Johnny is 13 and is much involved in sports, his favorite is hockey.)

Do you have other pets in your home?
Dog or Cat, Breed	Age	Sex	Spayed/ Neutered	Up-to-date Vaccines
		M F
		M F
		M F
		M F
More?  Yes   No (If you have indicate yes here, please give some details in comments section at the bottom of the page.)

If you have ever taken in a rescue before, indicate with what organization and describe the experience.

Indicate any experience you have had in training animals (ie. House training, basic commands, etc...).

If you would be willing to support a rescue with special needs indicate if you have had past experience in supporting a special needs pet.  Indicate what the special needs were.  Also, indicate what special needs you would be willing to take on.  Include behavioral issues with these needs (ie. resource guarding, fear, biting, health issues) 

What made you decide that a Rescue was right for you?

Have you even been in a situation where you were not able to keep a pet?  If yes please explain that situation.

Have you even been in a situation where you had to bring a pet to a shelter?  If yes, please explain.

If you travel, who will care for your dog while you are away?

What age group of pet are you looking for?
	“Puppy “ (<5 months )
	“Adolescent”  (5 – 15 months )
	“Adult”  (> 15 months )
Describe some issues that you think you might have to deal with in being a guardian to the age group of pet indicated.

Describe how you will train this dog.  (ie. clicker and rewards, commands, treats, obedience school)

Are you willing to housetrain?  If yes, using what methods.

What will you do if the dog has accidents in the house.

Do you understand and accept that a change in a dog's environment may cause the dog to have accidents, especially in early days of the adoption.  Explain how you intend to get them through that transition, to understand the new environment and what is expected of him.

Do you have a regular vet?		Yes		No
Name and Location of Vet: City  State Zip
May we contact the Vet for a recommendation?  Yes  No

What would you expect the annual cost of dog food, toys, vet care, grooming, etc. for your pet?

What is a reasonable amount to spend on your dog if he became sick.

Do you have other references you would like us to contact?

Do you have friends or relatives who would take care of this dog, or facilitate returning it to Displaced Pets Rescue, if you became unable to care for it?  If yes, please indicate name and contact information.

What circumstance would cause you to give up this pet?

Other information you wish us to know.

Are there questions and/or concerns that we can help you understand?

We are a non-profit organization.  The adoption donation is used to partially recover the costs involved in rescuing this dog.  These costs include but are not limited to: Shelter fees, spay/neuter, food, housing, vaccinations, de-worming, micro chip, and any vet exams or medical care that the dog may have required.  We would not have been able to save the life of the dog you applied for without the adoption donation from another that came before him/her.  Are you willing and able to make the donation fee?     Yes   No

We reserve the right to inspect all potential homes and yards prior to placement.  
Is this agreeable to you?      Yes  No

I have read the above carefully and have filled out this application honestly.  I understand that an omission and/or failure to answer all questions can result in the application being declined.  If an untruth is discovered after an adoption takes place, and this untruth puts the rescue animal at risk, I understand that Displaced Pets Rescue has the right to annul the adoption and reclaim the dog.       I agree  I dis-agree
 

Clicking this Submit button is your signature that all of the above is true.
This application becomes part of the adoption contract.

 

We can be contacted at 503-429-8019
Christy@DisplacedPetsRescue.com
between the hours of 10 AM to 6 PM
Please leave a message if I am not available.  Let me help.