1. Name of Applicant: * First Name Last Name 2. Age of Applicant: * 3. Name of Co-Applicant: First Name Last Name 4. Age of Co-Applicant: 5. Applicant's Address * Address 1 Address 2 City State/Province Zip/Postal Code Country 6. Applicant's Phone Number: * (###) ### #### 7. Applicant's E-Mail Address: * 8. Applicant's Employer, Position, Phone: * 9. Co-Applicant's Employer, Position, Phone: 10. Type or name of dog you are interested in: * 11. Veterinarian's Name and Phone Number: 12. Number of children in your home: * 13. Age(s) of children: 14. Do they live with you full-time? Yes No 15. Number of adults in your home: * 16. Is anyone usually home during the day? If so, who? * 17. Who will be responsible for caring for the dog? * 18. Do you consider the location of your home to be: * Suburban Urban Rural 19. Type of home * House Townhouse Condo Apartment Other 20. Do you own or rent? * Own Rent 21. If you rent, you MUST provide proof that you are allowed to have dogs. Landlord's name and phone number: 22. How would you describe the activity level in your home? Active Moderate Quiet 23. Do you have a fenced-in yard? Yes No 24. If yes, what type (material) and height of fence do you have? * 25. If fenced, how many gates do you have and how are they secured? 26. Why are you interested in adopting a dog? * 27. Rescued dogs may have behavioral and/or emotional issues. How are you and your family prepared to deal with these potential issues? * 28. How will the dog be kept: * Outdoors Indoors Equally indoors and outdoors 29. How long will the dog be left alone during the day? * 30. When the dog is home alone, will it be: Allowed free movement throughout the house Confined to a room Crated Left outdoors Kept in garage 31. What do you believe is the annual cost to properly care for a dog, including food, vet care, grooming, and other expenses? * 32. Do you believe spaying/neutering is vital in curbing the homeless pet population? * Yes No 33. Are your current animals spayed/neutered? * Yes No Currently no pets in the home 34. If no, why? 35. This dog could depend on you for the remainder of its life. Are you prepared to make that commitment? * Yes No 36. Have you ever given up a dog before? * Yes No 37. If yes, what was the reason? 38. For what types of behavior problems would you return a dog: * Excessive barking Housebreaking issues Chewing Shedding Digging Does not get along with other animals Other (Not listed) I would not return the dog; I would try to correct the problem(s) 39. If "Other", please describe. 40. To help resolve the problems, are you willing to crate-train? * Yes No 41. To help resolve the problems, are you willing to attend obedience class? * Yes No 42. What will you do with the dog when you are on vacation? * 43. What will you do with the dog if you move? * 44. Under what possible circumstances would you return the dog? * Moving New baby Divorce Personal illness High cost of care Other (Not listed) 45. If "Other", please describe. 46. Please list animals that you have previously owned, if any (excluding fish, rodents, and reptiles), describing what happened to them: * 47. Please list all animals that you presently own, if any (excluding fish, rodents, and reptiles). Please include animal, breed, age, gender, time owned, if neutered/spayed, if vaccinated, if on heart worm preventative? * 48. Provide the names and phone numbers of two references (i.e. co-workers, acquaintances, neighbors. NO family members) * 49. How did you hear about us? (e.g., facebook, adoptapet.com, a friend, adoption event...) Specific information can better help us promote rescue dogs. * 50. Individuals who adopt from K-9 New Life are contacted periodically for an update to help ensure the dog successfully adjusts to its new home. If you adopt a dog from K-9 New Life, will you consent to occasional contact to ensure the dog is doing well in your home? * Yes No 51. If at any time the adopter cannot keep the dog, it MUST be returned to K-9 New Life. By electronically signing below, I acknowledge that I have read this questionnaire completely, comprehend it fully, know that applying does not ensure approval, and untruthful answers or failure to comply with the requirements of this application or the adoption contract can result in the forfeiture of any K-9 New Life dog adopted by me. Electronic signature: * Date * MM DD YYYY Thank you! Adoption Application K-9 New Life reserves the right to refuse or deny any application for any reason other than race, creed, color, or religion.
