CODRL Adoption Application
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Please enter the County you live in (Franklin,Union, etc):
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| Your Email address
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| Birthday
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| Home Number
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| Cell Phone Number
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| Work Phone Number
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| Where are you employed? Can you receive calls at work? If so What times?
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| What is the name of the dog you are interested in?
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| What is your preference? Male or Female? If you have a preference, why do you prefer this sex? Please explain below
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| Do you own your own home? If you select NO, please complete the Name, address and phone for your landlord.
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| If you do not own your home or live in a condo or a home association, are you willing to mail us a copy of your lease/association rules, showing permission for you to have a pet?
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Yes No
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| Home setting: rural, semi-rural, suburban, wooded, busy road, please explain your location outside. Do you have a fenced yard, please tell us how you will assure the dog does not get loose if not. If you have a fenced/yard, please describe the height, size and material.
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| Name and describe each of your companion animals, cats and dogs. Indicate which ones are spayed or neutered
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| Who is your vet? Name, address and phone number also indicate the animals they have treated.
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| If you have had a companion animal pass away recently, give that animal's name and the associated vet clinic's name and phone number. Also List any animals that you no longer own, that did not pass away. What happened to them?
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***If you do not currently have a companion animal (and no vet reference) supply names and phone numbers of two references...co-workers, fellow congregants, or long time neighbors, Please no Family.
A description of the section goes here.
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| Reference Number One
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| Reference Number Two
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| Have you owned dogs in the past? (are you familiar with handling dogs?)
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Have owned dogs in past Have NOT owned a dog
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| Have you ever adopted from a rescue, a pound, or a Humane Society?
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| Which one?
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| Have you ever turned a cat or dog in to a rescue, pound, or Humane Society?
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| Please explain:
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| Please list all the residents of your home. Do you have children in your immediate family? (how many and ages) Please list ages of children likelyto visit your home as well.
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| Are you familiar with a home visit? (a volunteer in your area would come to your home to assess your family and property for fitness to adopt a dog, using a list of criteria provided by our organization) Would this be acceptable to you and others in the h
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| How long, typically, would the dog be left alone at any time?
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| Where will the dog be while you work? At night? While you are away from home? and while on vacation?
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| Are you at all familiar with crate training?
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Yes No
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| Do you have a crate?
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Yes No
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| Have you ever attended an obedience class with your dog?
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Yes No
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| How would you describe your family's relationship with a dog?
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| What do you feel is a good reason to return an adopted dog?
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| Please tell us what you know about the breed you are applying to adopt.
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| Since you are requesting to adopt a rescue dog that may have been traumatized to some way (whether by neglect, abuse, death or loss of a loved owner, or merely by being moved to different families a number of times how do you plan to help this dog adjust
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| Is there any further information about your family that would help us in deciding if a dog would be right for your home?
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| How did you hear about us?
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| Other explanation
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| Do all members of your household want to adopt this pet?
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yes no
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| If no, please be specific about who disagrees and why.
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| Do you have children? If so, what experience have they had with pets?
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| Who will be the primary caretaker for this pet?
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| Do you have a swimming pool or hot tub? Is it fenced separately from the rest of your yard? Does it have a secure cover that a pet cannot get under?
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| Have you or anyone in your household ever been convicted of cruelty or neglect? or Have you ever received a pet-related citation or been fined for violating a pet-related law?
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Yes No
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| If you answered yes to either question, please provide an explanation below.
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Image Verification
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