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Reference One *

If there are children in your home, what experience do they have with a dog?

Do you foresee any major changes in your lifestyle in the next 12 years (the average lifespan of a dog)? *

Yes

No

Employer Name and Address

How many days are you prepared to allow your new dog to adjust to your home? *

1-2 days

3-5 days

5-10 days

one month

Do You *

Own Your Home

Rent Your Home

Live with Family

If no, please explain

Have you ever house trained a dog before? *

Yes

No

Is anyone in your home allergic to an animal? *

Yes

No

If renting, does your lease specifically permit dogs?

Yes

No

With Permission

How will you exercise the dog? *

If yes, is it fully fenced in?

Yes

No

If yes, who and what species of animal?

Name or type of dog you are interested in *

Reference Two *

Birthdate (You must be 18+ years old to adopt) *

How much are you prepared to spend on emergency veterinary care if a situation arose? *

$300-$499

$500-$999

$1,000+

Position Held and Period of Time Employed

Have you lost a dog due to sickness in the last year? If so, please explain

Landlord's Name and Telephone

Do you have any plans to move within the next 12 months? *

Yes

No

Will you keep a collar with identification on your dog at all times *

Yes

No

How many hours a day will the dog be alone? *

City, State, Zip *

What would you do if the dog develops a problem with separation anxiety? *

Height of fence and material?

Happiness is a rescue dog.

Applications are kept for one month then discarded

Have all of your pets had a routine veterinary check up in the last 12 months?

Yes

No

How long have you lived at your current address?

Under 1 year

1 year - 5 years

5 years+

Thank you for contacting us. You will hear back from us within 48-72 hours.

If yes, please describe

Street Address *

Please list all people living in the same home as you, their relationship to you and their age: *

How do you plan to discipline the dog? *

Are all animals in your home spayed or neutered?

Yes

No

Please provide three references including one non-family member

Who will be the dog's primary caregiver? *

Are you willing to take the dog to a trainer if behavioral problems arise? *

Yes

No

What is heartworm and how do you prevent it? *

If you currently have a pet, please list name, age, breed

When traveling, how will the dog be taken care of? *

Where will the dog be kept during the day? *

Name: *

Please submit from a computer, applications submitted from a tablet or mobile device my not transmit to us.

If applying for a bully breed, what experience do you have with them and why are you interested in adopting one?

Why do you wish to adopt a dog? Check all that apply *

Companion

Companion for child

Companion for pet

Gift

Guard dog

To breed

If you do not have a dog, have you ever owned a dog? *

Yes, as an adult

Yes, as a child

No

Cell Phone

Have you ever returned or given away a pet? *

Yes

No

Is everyone in your home in agreement about adopting a dog? *

Yes

No

If less than one year, previous address:

Do you have a private yard? *

Yes

No

If you have other pets at home, how do you plan to integrate your new dog? *

What would you do if the dog develops a problem with resource protecting or guarding? *

Reference Three *

How do you plan to housetrain this dog if needed? *

Veterinarian

What would you do if the dog develops a problem with digging? *

What best describes your home? *

Single Family House

Condo/Townhouse/Apartment

Multi Family House

Mobile Home/Trailer

Email: *

Do you work from home?

No

Yes

Sometimes

Are there screens in all of your windows? *

Yes

No

Date Submitted *

Thank you for contacting us. You will hear back from us within 48-72 hours.

How often and where will you walk the dog? *

Where will the dog sleep at night? *

What would you do if the dog develops a problem with marking? *

ALL fields with an asterisk must be filled out, if Not Applicable, use N/A

If yes, please explain

Home Phone *

Adoption Application

This questionnaire is intended to help you consider many ways a pet will impact your life. The questions concern various aspects of pet ownership that should be given serious consideration before deciding to share your life with any animal. Remember, you are a pet’s lifelong commitment!

Adoption Donation: $475.00

Dogs are vetted, up to date on shots and most are spayed/neutered and microchipped. For dogs that are not spayed or neutered, you must provide proof of spay or neuter after adoption. You must be at least 18 years old to adopt.

NO REFUNDS AFTER 7 DAYS ON ANY ADOPTED ANIMAL

We are a volunteer organization and the adoption fee helps us recover the cost of transportation, basic medical expenses and care of each dog. We accept cash, venmo or credit card. PayPal is our credit card service provider, we are poorpawsrescue@gmail.com.

Copyright 2014. Poor Paws Rescue. All Rights Reserved.