DOG ADOPTION APPLICATION

DOG ADOPTION APPLICATION

Name________________________________________________ Home Phone ____________________

Address _____________________________________________ Work Phone _____________________

City ________________ State ______ Zip Code _____________ Cell Phone ______________________

Time at Current Residence _______/______ (years/months)

Drivers License / ID Number ____________ Exp. Date _________

Vets. Name: __________________________________ Vets Phone Number: ___________________

Reason(s) for Adopting:

Check as many as applicable

____ Family Companion

____ For My Children

____ Company for other dog

____ Guard/Protection

____ Hunting

____ Gift

____ Other

___________________

GENERAL INFORMATION

Do all the adults in your household know that you plan to adopt a dog? Yes No

Are there any household objections? Yes No

Does anyone in your household have any allergies to animals? Yes No

If Yes, can/will the allergies be controlled by medication? Yes No

Who will be the dog’s primary caretaker? (feed, train, exercise, groom, etc.) ___________________

Are you aware of the annual expenses associated with having a dog? Yes No

Are you prepared to assume the financial responsibility of providing your

dog with adequate food, medical care, housing, training, toys, etc? Yes No

Are you prepared to commit a life-long relationship with this dog? Yes No

Do you currently have any pets living with you? Yes No

If so, please list type (cat, dog, bird), etc.? ___________________________________________________

If you move, what will you do with your pets? _____________________________________________

Have you ever adopted an animal and returned it (for any reason)? Yes No

If so, what were the circumstances? ________________________________________________________

Briefly describe why it is that you are looking to adopt a dog? ___________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________

We are a non-profit dog rescue, who believes that every animal deserves a chance at life. Without people like you, these animals wouldn’t have that chance. We thank you for taking the time to accurately fill out this application, so that we can find you the perfect pet for you (and your family). We still need more information regarding your hopes and expectations in a pet. We also need to know what type of environment/home-life you will be providing for your pet. Please turn the application over and complete the other side.

YOU & YOUR HOUSEHOUSE (Check all that apply.)

Dog Experience:

____ Never had a dog ____ Only had cats

____ Had one or two ____ Taken care of

____ Have had many dogs for others

Dog Will Live:

____ Indoors Only

____ Indoors & Garage

____ Indoors & Outside

when at work

____ Indoors & Outside

____ Outside Only

Children & Your Home:

____ I have children

Ages ___________

____ I do not have children

____ Children visit my home

Ages ___________

____ No children visit my home

Your Living Place:

____ House

____ Condo

____ Apartment

____ Mobile Home

____ Other

___________

Do you own your home?

____ Yes

____ No, I am a renter

Do you have landlord approval to adopt a dog?

_______ Yes _______ No

____ Live with Parents

____ Other

Outside, I have:

____ Fenced Yard

________ feet high

________ material

____ Unfenced Yard

____ No Yard ____ Other

Typically, the dog would be left alone:

____ More than 9 hours

____ 8-9 hours

____ 5-8 hours

____ Rarely

Landlord’s Name: _____________________

Phone Number: ______________________

Complex Name: ______________________

Size/breed restrictions? _____ Yes _____ No

Please List: __________________________________

Home Lifestyle:

____ Very Active

____ Somewhat Active

____ Rather Quiet

Typically, the dog’s time would be spent:

______ Number of hours in a day kept outside

______ Number of hours in a day kept inside

HOPES & EXPECTATIONS (Check all that apply.)

Desired Characteristics:

(That you would like in a dog)

________ Very Active

________ Active

________ Calm

________ Outgoing

________ Confident

________ Reserved

________ Sensitive

________ Friendly

________ Playful

________ Submissive

________ Dominant

________ Gentle

________ Well-mannered

________ Affectionate

________ Independent

________ Dependent

________ Other

_____________________

Age:

____ 2 to 4 months (Like a baby/toddler)

____ 4 to 12 months (Like a young child/teenager)

____ 1 to 3 years (Like an energetic young adult)

____ 3 to 5 years (Like a sensible adult)

____ 5+ years (Like a mature/senior adult)

____ No Preference

Preferred Training Level of Dog:

____ I plan to train myself/seek professional training

____ Prefer a dog with some training

____ Prefer a dog that is fully obedience trained

____ Prefer a dog that is already house trained

____ Doesn’t matter

Activities with my dog:

____ Running/jogging

____ Daily Walks

____ Camping

____ Dog Park

____ Other

Breed:

____ Purebred

____ Mixed Breed

____ No Preference

Size of Dog:

____ Small, 5 to 20 lbs

____ Medium, 20 to 50 lbs

____ Large, 50 to 100 lbs

____ X-large, 100 + lbs

Coat:

____ Short

____ Medium

____ Long

____ No Preference

Sex:

____ Male

____ Female

____ No Preference

I declare that all of the information I have given above is true and complete. Providing false information or withholding information will void the application. I understand that Chow Chow Rescue of Northern California can decline my adoption application. I further understand that if my application is approved, Chow Chow Rescue of Northern California reserves the right to conduct a home check prior to the adoption of any animal to verify the suitability of my home environment as it relates to the needs of the animal, i.e., secure fencing, appropriate shelter, adequate space, safety, etc. I understand that adopting an animal from Chow Chow Rescue of Northern California provides no medical/behavior assurances whatsoever.

Signature _________________________ Print Name ____________________________

Date ____________

Chow Chow Rescue of Northern California (530) 885-0963

norcalchowrescue.com norcalchowrescue@yahoo.com