ADOPTION APPLICATION

Please allow at least 30 minutes to complete the adoption application. Since this is an email form, there is no way to partially save it. You must complete the form entirely before it will save successfully.

NOTE: Please use a current browser to avoid any issues with the application form.

    Dog Name (Optional)

    Reason for Adoption:
    Family CompanionPersonal ProtectionFor ChildGiftCompanion For Current DogReplace A Previous DogOther

    If Other, please explain why you chose this dog.

    If you're interested in a specific dog for adoption, please explain why you chose this dog.

    Type of Dog You Want
    Size:
    Sex:
    Age:
    Activity Level:

    Date you will be ready for your new dog (required)
    mm/dd/yyyy

    First Name (required)

    Last Name (required)

    Address (required)

    City (required)

    State (required)

    Zip Code (required)

    Home Phone (required)

    Cell Phone (required)

    Email Address (required)

    Number of adults in home (required):
    Please include ages in parentheses. Ex: "2 (35, 37)"

    Employers for all family members (required)

    Does Anyone in the home have special needs

    Number of children in home:
    Please include ages in parentheses. Ex: "2 (10, 12)"

    Please elaborate on all children(s) experience with dogs here. (required)

    Does anyone in your family smoke?

    Is everyone in the household in agreement on adopting a new dog? (required)

    Type of Household (required)

    Housing Status (required)

    Type of House (required)

    How long have you resided at your present address? (required)

    Are you planning a move? (required)

    If you are planning a move, when?

    (Renters) Landlord (or Condo Association) & Phone Number

    Please include phone number in parentheses. Ex: "John Smith (201-555-5555)"

    (Renters) Are pets permitted?

    Do you have a yard or fence? (required)

    If you have an enclosed fence, what is the height?

    If you have an enclosed fence, what material is it made from?

    If "Other", please describe fence material:

    If you do NOT have a completely enclosed fence or electronic fence how will you confine the dog to your property?

    Please Describe (in detail) how long the dog will be alone each day, including commute times to and from work. What time does the last person leave home in the morning and the first arrive in the evening? (required)

    Where will your new dog be kept while alone?(required)

    Are there specific areas of your home where the dog will not be allowed?(required)

    How will you exercise your dog?(required)

    How long will your dog be exercised daily?(required)

    Where will your dog sleep at night (required)

    Names of Primary Caretaker (s) of Dog (required)

    Will you be crate training your dog? (required)

    Have you ever crate trained a dog? (required)

    Do you own a crate?(required)

    Have you ever taken a dog to obedience training?(required)

    Do you understand that your dog may develop issues as it adjusts to your home?(required)

    Will you tolerate housebreaking accidents, chewing, or barking/whining? (required)

    What steps would you take to resolve any behavioral issues (required)

    Additionally, what issues would you NOT tolerate if any (required)

    Why do you want a new dog and How long have you been searching?(required)

    Is anyone in your house allergic or fearful of dogs? (required)

    If yes, please elaborate

    Do you have a nanny or or caregiver?

    Are they aware of this adoption and are they willing to take responsibility for the animal

    (OPTIONAL) If your pet will be alone during the day for extended periods, please list a dog walker, nanny or doggie daycare you would use. Please provide their contact information.

    (OPTIONAL)Please provide a description of animal allergies, if any:

    Do you have animals now? (required)

    List NAME, BREED, AGE, CURRENT WEIGHT and SEX. (required)

    Are they spayed/neutered?(required)

    If no, explain.

    Is Dog Up To Date On All Vaccines?
    YesNoN/A
    Is Dog Up To Date On Heartworm Prevention For Every Season?
    YesNoN/A
    Is Dog Up To Date On Flea/Tick Prevention For Every Season?
    YesNoN/A

    Have your animals ever been around other dogs?(required)

    List any animals you have had in the past 5 years. Include name, breed, sex, and how long you owned the pets.(required)

    Reason for no longer owning the pets?(required)

    Have you ever surrendered a pet (required)

    If yes why?

    Have you ever utilized training pads in the process of housebreaking a dog? If so, please elaborate on that usage.

    On your current/previous dogs which type of collar have you used?

    If Other please explain

    What kind of leash do you use for your current dog(s)?

    If Other, please explain:

    What brand of pet food do you feed your dog?

    Veterinarian Information...Contact your vet to alert them that we will be calling them.

    Vet Name:(required)

    City:(required)

    State:(required)

    Zip Code:(required)

    Phone:(required)

    Name of the person who the vet records are listed:(required)

    Reference #1 (First of two references...non-family members).

    Please list a reference that can attest to how you are with animals.

    First Name:(required)

    Last Name:(required)

    Relationship:(required)

    City:(required)

    State:(required)

    Daytime Phone Number:(required)

    Evening/Weekend Phone Number:(required)

    Reference #2 (Second of two references...non-family members).

    Please list a reference that can attest to how you are with animals.

    First Name:(required)

    Last Name:(required)

    Relationship:(required)

    City:(required)

    State:(required)

    Daytime Phone Number:(required)

    Evening/Weekend Phone Number:(required)

    Reference #3.

    Please list a non-family reference that can attest to how you are with animals.

    First Name(required):

    Last Name(required):

    Relationship(required):

    City(required):

    State(required):

    Daytime Phone Number(required):

    Evening/Weekend Phone Number(required):

    Where did you hear about us?(required)

    If "other", please explain:(required)

    ADOPTION AGREEMENT: You MUST CHECK ALL the following (required)
    a. I understand that adopting a dog is a 10-15 year commitment.
    b. I understand that I must take my pet to the vet for annual wellness exams and necessary vaccinations.
    c. I understand that Home for Good Dog Rescue has the right to conduct a home visit.
    d. I certify that all information in my application is true and there are no misrepresentations.
    e. I certify that I have read, understand & agree to abide by the terms of the adoption process (Listed below).

    Read Adoption Process Terms

    Please prove you are human by selecting the Key.