Dog Habitat Rescue Adoption Application

Pet You Are Interested in:
How were you reffered to
Dog Habitat Rescue:

Applicant Information

Applicant
Prefix
First
Last
Suffix
Co Applicant
Prefix
First
Last
Suffix
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Phone Number

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####
Email
What kind of home do you live in?
 Apartment 
 Condo 
 House 
Do you Rent or Own?
Landlord's Name:
Landlord's Phone:

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How long have you lived here?
Do you plan to move?
Employer:
Employer Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country

House Hold Information

Household Yearly Income:
Number of Adults in the Home?
Everyone has agreed to adopting a pet?
Are there any children in the home?
Is anyone allergic?
Why would you like to adopt a pet?

Pet History

Please list Prior Pets Breed, Age, Gender and current Status:
Have you ever given up a pet before? If so what were the circumstances?
Vet Name
Vet Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Vet Phone Number

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New Pet Information

How long have you been looking?
What are you looking for?
Breed: Purebred, Mix or
No Preference
Age:
Energy Level:
Size:
Coat Type: Long, Medium, Short or Hypo-Allergenic
What brand of food will you feed your pet?
How often will you feed your pet?
Are you able to afford an $200 - $800 vet bill in case of an emergency?
How much do you expect to spend on yearly maintenance?

Home and Family Life

Do you have a fenced in yard?
Where is your dog's place at home?
How long would you allow for our rescue to adjust to his new home?
How many hours per day will he/she be alone?
How do you plan to interact with your pet?
Where will your rescue be kept during the day?
And in the evening?
How many times a day will your dog be outside?
Are you committed to caring for your new pet for 15+ years?
If you have to move, what will you do with your pet or pets?
Do you travel frequently?
Who will look after your pet if you need to travel?

Activities and Training

Do you plan on taking your pet to obedience training?

What would you do if your dog develops problems with:

Digging:
Barking:
Chewing:
Seperation Anxienty:
Aggression

References:

Please list three references, with name phone and relationship:
1.
2.
3.

Signatures

By providing your name(s) below, I certify that the information I have given is true. I understand that Dog Habitat Rescue reserves the right to deny my application for any reason. I further authorize the investigation of all statements in this application.
Applicant
Date

MM
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DD
/
YYYY
Co Applicant
Date

MM
/
DD
/
YYYY
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