Rescued Tails Animal Sanctuary Dog Adoption Application

Animal #_________________ Microchip # __________________________
Dog’s Name______________________

(Please print all information below legibly)

___________________________________________________________
Applicant’s Name(s)

_____________________________________________________________ Street Address				   City 		  State	      Zipcode

Home Phone:_________________________

Work Phone:_________________________

Cell Phone 1:_________________________

Birthdate:_________________

E-mail Address:_____________________________________________

About Your Decision
When deciding on a dog, which of the following were factors in making your decision: (check all that apply)
___Breed			___Gender			___Size	
___Energy level 		___Color			___Observed behavior ___Noted behavior		___Cost			___Obedience trained
___Grooming considerations	___Rescue dog

How long have you been looking to add a dog to your family?______________________
Would you be interested in fostering a dog? ____________________
What is the primary reason you are getting a dog at this time? ________________________________________________________________________
Have you looked at other shelters or rescue groups for adopting a dog?  YES  /  NO      
What attracted you to this particular dog?____________________________________
_____________________________________________________________________

About Your Family 

How many people are in the household?_______________________________

Wife works:  Part time/Full time/Not applicable  Occupation:______________________
Husband works:   Part time/Full time/Not applicable    Occupation:_________________

What are the ages of any children:____________________________________________

What other animals do you have in the household?______________________________

Where do other pets live during the day? ______________________________________
			    during the night? _____________________________________

Do any of the family members have allergies to animals?    YES    /    NO

About Your Environment 

Do you have a fenced in yard?   Yes    /    No   /    Not yet
     
If yes, what type of fencing is it?    Chain Link    /    Privacy    /    Invisible
     If yes, how high is the fencing?_____________________
     
If no, how will the dog be contained when outside?_____________________________

Where will the pet be kept when you are not home?_____________________________

Where will the pet be allowed in the home?____________________________________

Where will the pet sleep at night?____________________________________________

About Your Living Situation 

Do you  OWN    /    RENT  ?        (Written approval from landlord required if renting)
If renting, Landlord’s Name_______________________________________Phone:______________________

Type of Dwelling?   House / Duplex  / Apartment / Mobile Home / Townhouse/  Condo    

Does your living situation have animal restrictions (e.g. breed, size, # of animals, etc.)?  YES  /  NO

Do you belong to a neighborhood or mobile home association? YES / NO
(Written approval from association required)

About Your Day 

Briefly describe a typical day for you and your family (please list times as appropriate)

  
Behavior Considerations 

Please rate each of the following behavior issues as follows: 
1 =  Been there, done that, can handle without help
2 =  New to me, but know how to handle situation myself 
3 =  New to me, would get help to solve the problem
4 =  Been there, cannot handle, dog would need to be returned
5 =  New to me, cannot handle, dog would need to be returned
                   6 =  Don’t consider it a problem (please note why)
                      
_____Potty training accidents_______________________________________________
_____Being mouthy when playing___________________________________________
_____Biting while protecting a toy/food_______________________________________
_____Playing too rough with other pets_______________________________________
_____Forging when walking________________________________________________
_____Not coming when called_______________________________________________
_____Jumping fence_______________________________________________________
_____Digging ___________________________________________________________
_____Begging for food_____________________________________________________
_____Won’t get off of furniture______________________________________________
_____Doesn’t like to be groomed_____________________________________________
_____Fighting with other dogs_______________________________________________
_____Chasing cats________________________________________________________
_____Jumping up on you___________________________________________________
_____Biting a person______________________________________________________

Basic Care

Are you willing to assume ALL veterinary costs for this pet from the date of this adoption forward?  Yes / No
Do you know what steps to take if your pet runs away?   Yes  /    No

Who will be the primary caretaker of the pet?________________________________
Who will feed the pet?____________________________________________________
Who will exercise the pet?_________________________________________________
Who will groom the pet?__________________________________________________
Who will train the pet?____________________________________________________
What type of exercise will you participate in with your pet?_______________________
_______________________________________________________________________
Obedience Knowledge

Have you ever taken a dog to an obedience class?	Yes / No
	If yes, when: ________________________________
	If yes, where: ________________________________
	If yes, why: _________________________________

Do you think it is a good idea for all dogs to attend a basic obedience class? Yes / No

Do you think that you will be taking your new dog to an obedience class? Yes / No

Do you own any books on dog obedience training? Yes / No

What commands have you successfully trained a dog to do:

SIT / COME / STAY / DOWN / OFF / HEEL / STAND / OTHER__________________

Family Pet History

Have you ever had a pet before?  YES  /  NO

If yes, please list:

1)Name:____________________ Type of animal_______________________________
Date(s) pet lived with you:_______________________
What happened to pet?  Surrendered/Given away  /  Deceased  /  Ran Away  /  Still have
If checked anything other than “Still have”, please explain: _____________________
________________________________________________________________________

2) Name:____________________  Type of animal_______________________________
Date(s) pet lived with you: _____________________
What happened to pet?  Surrendered/Given away  /  Deceased  /  Ran Away  /  Still have
If checked anything other than “Still have”, please explain: _____________________
________________________________________________________________________
3) Name:____________________ Type of animal_______________________________
 Date(s) pet lived with you:______________________
What happened to dog?  Surrendered/Given away  /  Deceased  /  Ran Away  /  Still have
If checked anything other than “Still have”, please explain: ____________________
________________________________________________________________________

References

List three references – one being your veterinarian if you have, or have had, animals

1.	Name_____________________________________________
Phone number_________________________
How do you know this person?______________________

2.	 Name_____________________________________________
Phone number_________________________
How do you know this person?______________________

3.	Name_____________________________________________
Phone number_________________________
How do you know this person?______________________

If for any reason you are unable to take care of this animal, it MUST be returned to Rescued Tails Animal Sanctuary.

We reserve the right to determine whether or not it is in the best interest of the animal to be adopted by any individual, and if not, to refuse the adoption.

Applicant’s Name (please print): _________________________ Date:_______________
Applicant’s Signature: _____________________________________________________
Adoptive Representative: __________________________________________________

There will be a $25.00 service charge for all returned or non-sufficient fund checks.

For office use only:
Method of payment:     Check    /    Cash
Check #__________________________
Animal #:___________________