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 Information

Name of the dog you are interested in: *

First Name *

Last Name *

Age: *

Occupation

Spouse/Significant Other

Age:

Occupation

If this relationship were to change, with whom would the dog(s) remain?

Street Address: *

Home Phone:Area Code - Phone Number

Work Phone:Area Code - Phone Number

Cell Phone: *Area Code - Phone Number

City, State, Zip *

Email *

How would you rate your level of dog owning experience? *

First time ownerBeginnerIntermediateAdvanced

Household Information

Are all members of your household in agreement with this adoption? *

YesNoDon't Know

Who will be the pet's primary caregiver?ith whom would the dog(s) remain? *

Do you live in a *

HouseApartmentCondoMobile Home

Years at Residence *

Do you own or rent? *

OwnRent

If rent, provide name and phone number of landlord:

Does your landlord allow dogs?

YesNo

Are there any restrictions from your landlord or subdivision? *

Number of petsSize or weightBreed restrictionsNone

Do you have a fully fenced yard? *

YesNo

Is there anybody home during the day? *

YesNo

If 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?

YesNo

If your children did not want a dog, would you be interested in adopting a dog for yourself?

YesNo

Does anyone in your home have allergies to dogs or have asthma? *

YesNo

Additional Information

Please 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 Name

Co-Adopter's Phone Number

Co-Adopter's Address

Please 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 Information

What 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?

YesNo

Have you ever given a pet away

YesNo

If yes, what were the circumstances?

Have you ever allowed an animal to breed?

YesNo

Grooming, Veterinarian, and Care

Please 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?

YesNo

If your dog(s) needed acute medical attention for an illness or emergency care, are you prepared to handle the expense?

YesNo

Who will groom and bathe your dog(s)?

Would your dog(s) wear a collar?

YesNo

What kind of food will you feed the dog(s)?

Would you allow your dog(s) to wear a permanent Rescue I.D. tag?

YesNo

What 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 back

New Pet Information

What 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?

YesNo

What rooms are off limits to the dog(s)? *

Will your dog(s) be allowed on furniture?

YesNo

How 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? *

Do you have a doggie door?

YesNo

How will you supervise the dog's outdoor activity? *

Preferred level of exercise with dog(s)?

Couch PotatoShort WalksVigorous WalksHikes/Runs

How do you normally walk your dog(s)? *

On LeashOff Leash

When on leash what do you normally use? *

Collar OnlyChoke ChainHarnessOther

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *

YesNo

Are you willing to work through your new pet's issues, if any? *

YesNo

How 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 Signals

Will you agree to consult and pay for a trainer or behaviorist if any problems develop? *

YesNo

What 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? *

YesNo

Have you adopted from an animal welfare group before?

YesNo

If yes, what group?

Have you ever been denied adoption by a shelter, other rescue, or humane group?

YesNo

Please read and initial each statement below

I 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 Out

Why 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.

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Together we can make a difference and help those without a voice!

WALK ME HOME RESCUE GROUP

Dog Adoption Application

How would you rate your level of dog owning experience? *

What are your primary reasons for wanting a dog(s)? *

Are all members of your household in agreement with this adoption? *

Do you live in a *

Do you own or rent? *

Does your landlord allow dogs?

Are there any restrictions from your landlord or subdivision? *

Do you have a fully fenced yard? *

Is there anybody home during the day? *

Have your children been around animals before?

If your children did not want a dog, would you be interested in adopting a dog for yourself?

Does anyone in your home have allergies to dogs or have asthma? *

Have your dog(s) been vaccinated?

Have you ever given a pet away

Have you ever allowed an animal to breed?

Will you provide annual vaccinations and any necessary medical care?

If your dog(s) needed acute medical attention for an illness or emergency care, are you prepared to handle the expense?

Would your dog(s) wear a collar?

Would you allow your dog(s) to wear a permanent Rescue I.D. tag?

What would you do, if your dog(s) has gotten out? *

Which of the following reasons might prompt you to give up your dog? *

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?

Will your dog(s) be allowed on furniture?

Where will the dog(s) sleep at night? *

What outside areas are available to the dog(s)? *

Do you have a doggie door?

Preferred level of exercise with dog(s)?

How do you normally walk your dog(s)? *

When on leash what do you normally use? *

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior? *

Are you willing to work through your new pet's issues, if any? *

How would you train your dog(s)? *

Will you agree to consult and pay for a trainer or behaviorist if any problems develop? *

Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for? *

Have you adopted from an animal welfare group before?

Have you ever been denied adoption by a shelter, other rescue, or humane group?

How did you find out about Walk Me Home Rescue?

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