WALK ME HOME RESCUE GROUP Dog Adoption Application This questionnaire has been designed to help us in determining if potential adoption homes are prepared to assume the type of responsible ownership we strive to assure for our rescued animals. The goal is to be thorough; not invasive. Please answer all questions honestly and feel free to add your own comments. Please keep in mind that providing false information will result in the nullification of this application. Thank you.Completion of this application does not guarantee adoption of this pet.Applicant InformationName of the dog you are interested in: *First Name *Last Name *Age: *OccupationSpouse/Significant OtherAge:OccupationIf this relationship were to change, with whom would the dog(s) remain?Street Address: *Home Phone:Area Code - Phone NumberWork Phone:Area Code - Phone NumberCell Phone: *Area Code - Phone NumberCity, State, Zip *Email *How would you rate your level of dog owning experience? *First time ownerBeginnerIntermediateAdvancedWhat are your primary reasons for wanting a dog(s)? *CompanionGiftFor your childrenFor other petWatchdog Household InformationAre all members of your household in agreement with this adoption? *YesNoDon't KnowWho will be the pet's primary caregiver?ith whom would the dog(s) remain? *Do you live in a *HouseApartmentCondoMobile HomeYears at Residence *Do you own or rent? *OwnRentIf rent, provide name and phone number of landlord:Does your landlord allow dogs?YesNoAre there any restrictions from your landlord or subdivision? *Number of petsSize or weightBreed restrictionsNoneDo you have a fully fenced yard? *YesNoIs there anybody home during the day? *YesNoIf so, who?How many adults are in your household? *How many children are in your household? *If children, what are their ages?Have your children been around animals before?YesNoIf your children did not want a dog, would you be interested in adopting a dog for yourself?YesNoDoes anyone in your home have allergies to dogs or have asthma? *YesNo Additional InformationPlease briefly describe your lifestyle (active, social, homebodies, etc.)How is your general health (health issues)?Adopters over the age of 70 are required to have a co-adopter in case of an accident or death. If this applies to you, who would be your co-adopter? Co-Adopter's NameCo-Adopter's Phone NumberCo-Adopter's AddressPlease give 2 additional references. These may be friends, co-workers, or relatives. (1) Name (2) Relationship (3) Email Address (4) Phone Number Current/Previous Pet InformationWhat pets do you currently have? (Type, Breed, Age, Gender, Spayed/Neutered, Where obtained?)What pets have you had in the past? (Type, Breed, Age at death, Gender, Spayed/Neutered, What happened?) *Have your dog(s) been vaccinated?YesNoHave you ever given a pet awayYesNoIf yes, what were the circumstances?Have you ever allowed an animal to breed?YesNo Grooming, Veterinarian, and CarePlease provide the name and phone number of your current and/or previous veterinarian or clinic:We may contact your veterinarian to verify information.Will you provide annual vaccinations and any necessary medical care?YesNoIf your dog(s) needed acute medical attention for an illness or emergency care, are you prepared to handle the expense?YesNoWho will groom and bathe your dog(s)?Would your dog(s) wear a collar?YesNoWhat kind of food will you feed the dog(s)?Would you allow your dog(s) to wear a permanent Rescue I.D. tag?YesNoWhat would happen to your pets if you moved:Locally? *Out of state? *Out of country? *What would you do, if your dog(s) has gotten out? *Check SheltersPut up FlyersFlyers from Door to DoorWait for the animal to come backWhich of the following reasons might prompt you to give up your dog? *Excessive BarkingBitingDiggingDivorcePoor WatchdogSheddingDestructive ChewingFinancial ProblemsAccident IndoorsGrowling at GuestsExcessive Vet BillsAllergiesNew Spouse/Partner doesn't like dogAggressive on LeashLong term medical issueNone of the Above New Pet InformationWhat type of personality do you want your pet to have? (i.e. calm, energetic, protective, couchpotato) *Are you willing to live with hair on the furniture, stains on your rugs, a warm body on your bed, and an animal that might be destructive at times?YesNoWhat rooms are off limits to the dog(s)? *Will your dog(s) be allowed on furniture?YesNoWhere will the dog(s) sleep at night? *Dog HouseGarageLaundry RoomKitchenMaster BedroomChild's RoomBathroomHow many hours each day will your new pet be home alone? *Where will your new dog stay when nobody is home? *When will the dog be inside? *When will the dog be outside? *What outside areas are available to the dog(s)? *Fenced YardEnclosed PatioGarageBalconyDog HouseUnfenced Common AreaDo you have a doggie door?YesNoHow will you supervise the dog's outdoor activity? *Preferred level of exercise with dog(s)?Couch PotatoShort WalksVigorous WalksHikes/RunsHow do you normally walk your dog(s)? *On LeashOff LeashWhen on leash what do you normally use? *Collar OnlyChoke ChainHarnessOtherAre you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *YesNoAre you willing to work through your new pet's issues, if any? *YesNoHow do you plan on housebreaking your dog(s) if it isn't already?How would you train your dog(s)? *Obedience ClassHitFirm Verbal CommandClicker/Hand SignalsWill you agree to consult and pay for a trainer or behaviorist if any problems develop? *YesNoWhat length of time will you allow your new pet to adjust to his new home? *Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for? *YesNoHave you adopted from an animal welfare group before?YesNoIf yes, what group?Have you ever been denied adoption by a shelter, other rescue, or humane group?YesNo Please read and initial each statement belowI understand that a home visit does not guarantee placement. *I agree to provide my own collar, leash, harness, and tag at the time of completing the adoption contract. *We reserve the right to refuse adoption to any applicant for any reason. This questionnaire becomes part of the contract. *Thank you for taking the time to complete this application. The goal is not to be invasive but to find the best possible home for each animal. Please put your name and the date.First Name *Last Name *Date Help Us OutHow did you find out about Walk Me Home Rescue?Adoptapet.comPetfinder.comFacebookFriend/Family MemberOther websitePetSmartWhy are you interested in adopting from a rescue?I understand that I assume full responsibility for the welfare of this pet from the date of adoption.Submit DONATE NOW Together we can make a difference and help those without a voice!