EmailMe Form - ADOPTION APPLICATION

Date

Dog Interested In

Name *

First Last

Age *

Email *

Phone *

### - ### - ####

Address *

Street Address City State / Province / Region Postal / Zip Code

Employer

Employer Phone

### - ### - ####

Spouse's Information

Spouse's Name

Spouse's Email

Spouse's Employer Phone

Spouse's Employer

Personal Reference #1

Reference Name *

First Last

Reference Phone *

### - ### - ####

Best Time to Call *

Reference Email *

Personal Reference #2

Reference Name *

First Last

Reference Phone *

### - ### - ####

Best Time to Call *

Reference Email *

Your Veterinarian

Veterinarian Name *

Veterinarian Phone

### - ### - ####

Pets

Have you ever adopted a hound from us before?

Have you ever owned a Coonhound or Bloodhound?

Why do you want a Coonhound or Bloodhound?

How many pets do you currently own? *

Pet #1 Currently Owned

Type/Breed
Sex
Spayed or neutered?

Age
How long owned?
Inside or outside?

Pet #2 Currently Owned

Type/Breed
Sex
Spayed or neutered?

Age
How long owned?
Inside or outside?

Pet #3 Currently Owned

Type/Breed
Sex
Spayed or neutered?

Age
How long owned?
Inside or outside?

Pet #1 No Longer Owned

Type/Breed
Sex
Spayed or neutered?

Age
How long owned?
What happened to pet?

Pet #2 No Longer Owned

Type/Breed
Sex
Spayed or neutered?

Age
How long owned?
What happened to pet?

Pet #3 No Longer Owned

Type/Breed
Sex
Spayed or neutered?

Age
How long owned?
What happened to pet?

Your Housing Situation

Do you *

If renting, please provide landlord's name and phone number

Do you have a securely fenced yard?

If no fenced yard,are you willing to

Your Household

Number of Adults in Household

Number of Children in Household

Ages of Children in Household

How much contact with grandchildren/neighborhood children/other children?

Are any of your household members frail or fall risks?

If yes, please describe.

Do any of your household members have animal-related allergies?

If yes, please describe.

Dog Fitting Into Household

Who will be primarily responsible for the care of the dog?

What are the working hours of the adults in the household?

Where will the dog sleep at night?

Where will the dog be kept during the day?

How many hours per day will dog be left alone?

Where will the dog be kept when left alone?

Please describe how you will exercise the dog

Please describe your lifestyle. Is it active (e.g., hiking, camping, community work, in or out a lot)?
Or is it more relaxed and structured?

Please describe your perfect dog. Taking into consideration that hounds vary greatly in temperament, personality,
and activity level, what characteristics
do you want in your dog?
Please answer with as much detail as possible.

Please tell us what characteristics
are undesirable. Please answer with as much detail as possible.

Would you accept an older dog?

Would you accept a dog that has been abused?

Would you accept a dog that is not reliable with children?

Would you accept a dog that has a physical handicap?

Would you accept a dog that requires regular
medical treatment for a disorder or disease?

Knowing some of the rescue dogs have had little or no training, are you willing to take the dog to a trainer or to obedience classes?

How would you handle adjustment/training if dog jumps on furniture?

How would you handle adjustment/training if dog jumps on people?

How would you handle adjustment/training if dog barks?

How would you handle adjustment/training if dog chews?

How would you handle adjustment/training if dog not housetrained?

For what reason(s) would you give up your dog? (please describe all that apply, such as allergies, not getting along with other pets, divorce, not housebroken, moving, aggression, new baby, increased work hours, etc. ) *

What would you do if you were faced with an unexpected vet bill of $1,000 for treatment required to save your dog's life?

Have you ever given a pet up?
If so, please explain the circumstance.

What do you consider a reasonable time period to give the dog to adjust to your family and environment?

Are you willing to let a member or someone appointed by
American Black and Tan Coonhound Rescue visit your home before adoption?

What age and sex of dog do you prefer?

Please include any additional comments, information, etc. below that would help us help you find that perfect member for your home and environment. Our goal is to place our wonderful hounds in "forever" homes where everyone is happy--hounds and humans.

If you are located more than 250 miles away from your desired dog, what resources are available to you to pick up the dog or will you require transport assistance?

By submitting this Adoption Application to American Black & Tan Coonhound Rescue I certify that I am at least 21 years of age and that I will be the legal owner of and ultimately, soley responsible for the care and well-being of any dog that I adopt from American Black & Tan Coonhound Rescue. Any misrepresentation of the true facts in this adoption application or in the adoption agreement will invalidate the adoption agrement and will give American Black & Tan Coonhound Rescue the right to reclaim the adopted dog without refund of the adoption fee.