Southern Counties Rescue ~ Dog Adoption Application

Thank you very much for taking the time to complete the application. I would appreciate it if you answer every question. Please give as much detail as possible, providing phone numbers and appropriate contact persons where requested. In most cases the adoption fee is a minimum donation of $300 and it is less than our expenses. You must be 23 years of age or older to adopt. Completion of the application doesn't guarantee adoption.

All dogs are spayed/neutered, microchipped, current on vaccinations, dewormed and flea free.
Driver's License information will be requested when you adopt. Please have your driver's license with you.

Applicant Name: *

Occupation: *

Name of spouse/partner: * 🛈

Occupation: *

Street address *

City *

State *

Zip Code *

List home Phone *

List cell phone *

List work phone *

Best to Call *

Email address person 1: *

Email address person 2:

Email: *

List any additional people living with you and their relationship to you *

Ages of children *

Name and age of primary caretaker of dog: *

Please explain your children's prior experience with dogs: *

If applying for a specific dog what is the dog's name? If not, is there a breed or look & size? *

Why are you looking to adopt a dog? (please check all that apply) *

Do you live in a: *

Do you own or rent? *

How long have you lived at this address? *

Landlord's permission to have a pet? *

Landlord's name & phone number" * 🛈

Do you plan to move in the near future? *

When?

Where:

Please: *

What material is the fence

Are all gates locked? *

No

Yes

Gate(s) heights? *

What is the Front yard and Back yard fence's height at it's highest and lowest point? *

Have you recently inspected your fence and found it to be secure without holes or gaps? *

Yes

No

Who has access to yard? *

Do you object to a home visit? *

No

Yes

Will this dog be: *

How many hours per day will the dog be left alone? *

Where will dog be left? *

Is there anyone home during the day? *

Yes

No

If so who?

Explain outdoor access, circumstances & how long: *

Will pet be allowed on furniture? *

Where will the dog sleep at night? *

What areas of the house will be off limits? *

Do you have a limit on the cost of vet treatment? *

Yes

No

How much is too much? How much is too much?

Your Veterinarian’s name and city where located: *

Vet's phone number: *

List all dogs you have now & in the past 10 years. If no dog, enter "none" in Dog 1 Name.

Dog 1 Name: *

Age:

Sex:

Spay/Neutered:

Breed: 🛈

Size:

Personality, does it get along with other dogs and where did it come from?

0/250 characters

Still Own? If no, why do you no longer have this dog? If deceased, from what illness or accident?

Yes

No

Why no longer? Why no longer?

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Dog 2 Name:

Age:

Sex:

Spay/Neutered:

Breed: 🛈

Size:

Personality, does it get along with other dogs and where did it come from?

0/250 characters

Still Own? If no, why do you no longer have this dog? If deceased, from what illness or accident?

Yes

No

Why no longer? Why no longer?

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Dog 3 Name:

Age:

Sex:

Spay/Neutered:

Breed: 🛈

Size:

Personality, does it get along with other dogs and where did it come from?

0/250 characters

Still Own? If no, why do you no longer have this cat? If deceased, from what?

Yes

No

Why no longer? Why no longer?

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Additional Dogs: enter about each - names, sex, age, breed, personality, where now, if deceased, cause of death?

0/250 characters

List all cats you have now & in the past 10 years. If no cat, enter "none" under cat name.

Cat 1 Name: *

Spay/Neutered:

Declawed:

Has it been around dogs?

Breed (or brief description), age, sex, personality and where did it come from?

0/250 characters

Still Own? If no, why do you no longer have this cat? If deceased, from what?

Yes

No

Why no longer? Why no longer?

Cat 2 Name:

Spay/Neutered:

Declawed:

Has it been around dogs?

Breed (or brief description), age, sex, personality and where did it come from?

0/250 characters

Still Own? If no, why do you no longer have this cat? If deceased, from what?

Yes

No

Why no longer? Why no longer?

Additional Cats: enter about each - names, sex, age, personality, where now, if deceased, cause of death?

0/250 characters

------------------- General Information ----------------------

Were you ever in a situation where you were not able to keep a pet? If yes, please explain: *

0/450 characters

Do you travel often? Who would take care of your pet when you travel? *

Yes

No

Caregiver: Caregiver:

Are you able to talke care of this dog for its entire life (dogs can live 10-20 years)? *

Yes

No

If you are unable to care for the dog who will take it? Name/Phone number/Relationship *

Do you expect any major changes in your life in the next five years? *

Yes

No

Highly unlikely

If yes, please check what they might be:

Under what circumstances would you not be able to keep this new pet? (Please check all that apply) *

If you are adopting a puppy do you promise to enroll the puppy in obedience training appropriate for it's age and size? *

Yes

No

Maybe

Would you agree to consult and pay for a trainer if problems develop? *

Yes

No

Not sure

Please provide any additional information you want to share.

THIS APPLICATION BECOMES PART OF OUR CONTRACT:

I certify that all the above information is true and accurate. I understant that if I adopt a pet from Southern Counties Rescue, this document will become part of the adoption record.

Date: * 🛈 +

Signature: *

Thank you for completing this Application. Someone should get back to you within 2 days. If you do not hear from someone please email soCountiesRescue@att.net. Please remember we are all non-paid volunteers with other jobs.

Companion for self/spouse	Companion for pet	Watchdog
Companion for children	Replace deceased dog	Replace lost dog
Gift	Other (explain): Other (explain):

Check if you have a doggie door	Check if all windows have screens
Check if you have a screen door	Check if any window screens are broken or missing
Check if you have a balcony	Check if you have french doors
Check if you have a fenced front yard	Check if you have a fenced backyard
Check if you have a pool	Is the pool securely fenced? Is the pool securely fenced?

Move out of state	Move overseas	Get married
Change career	Have baby or adopt	Acquire roommate
Increase travel	Decrease travel	Downsize home
Move to larger home	Training/Schooling	Other Other

Personal changes for you	Divorce/Separation
New Spouse	Pregnancy
New Baby	New roommate
New Allergy	Job change/loss
Disability/Illness	New house/apt.
New carpet/drapes/furniture	Dog's Behavior Problems
Kids too rough with pet(s)	Dog too rough with kids
Does not get along with other pet(s)	Destructive, chews
Keeps you awake	Destroys furniture, walls
"Barks” too much	Needs too much attention/time
Taking too long to adjust to family (over 4 weeks)	Dog's general health problems
Dog incurs expensive vet bills	Requires daily medical treatment
Needs special diet	Dog becomes disabled
None of the above (please don't check this lightly)	Other reasons (explain) Other reasons (explain)