First Name *

Last Name *

Email *

Home Phone

Work Phone
x

Cell Phone *

Date of Birth *

Physical Address: *

City: *

State: *

Zip: *

Mailing Address: *

City: *

State *

Zip: *

Previous Address: (For less than 2 years at above address)

City:

State:

Zip:

Name of Spouse/Significant Other:

Spouse/Significant Other Phone:

Driver’s License # *

Driver’s License State *

I certify I am at least 18 years of age: *

Current Occupation *

How many hours do you work per week? *

Spouse/Signicant Other Occupation *

How many hours per week do they work?

Home Environment

What is your housing situation?

Other:

I live in a:

Other:

Do you have permission from the landlord/HOA & household members to adopt a dog? *

Are there lease/HOA rules that would stop you from building proper containment? *

Name and phone # of landlord/property owner:

Is your back yard fenced? *

What is height of fence?

How big is your back yard?

Width *

Length *

What type of material?

Other:

Does Fencing have:

Are you willing to install dig guards?

Do you own an outdoor kennel run? *

Run size:

Width:

Length:

If dog(s) requires kennel run, are you willing to build one? *

Do you have a pool? *

Does your gate have a lock? *

Do you have a crate? *

Do you have a doggy door? *

Why do you want to adopt a rescue dog? *

What are you looking for in a dog? *

Dog will be kept primarily?

% Inside *

% Outside *

When not home, where will dog be kept? *

Where will dog sleep? *

Do you agree to keep current license and I.D. tag(s) on dog at all times? *

Do you agree to obey all leash laws? *

How many adults live in your home? *

Number of children in home? *

Please list names & ages of adults and children

Name & Age *

Will this person be caring for adopted dog?

Name & Age

Will this person be caring for adopted dog?

Name & Age:

Will this person be caring for adopted dog?

Name & Age:

Will this person be caring for adopted dog?

Name & Age:

Will this person be caring for adopted dog?

Name & Age:

Will this person be caring for adopted dog?

Name & Age:

Will this person be caring for adopted dog?

Name & Age:

Will this person be caring for adopted dog?

Please list any other adults or children in the home, their age, and whether they would be caring for the adopted dog:

Anyone at home who may be adversely affected by a dog(s)? Allergies, Fear etc.? *

Are you aware that large dogs may jump up and knock down children and/or the elderly? *

Current Pets

What type of pet? (Dog, Cat, Bird, Reptile, Rabbit, etc.)

Breed:

Gender:

Age:

What type of pet? (Dog, Cat, Bird, Reptile, Rabbit, etc.)

Breed:

Gender:

Age:

What type of pet? (Dog, Cat, Bird, Reptile, Rabbit, etc.)

Breed:

Gender:

Age:

What type of pet? (Dog, Cat, Bird, Reptile, Rabbit, etc.)

Breed:

Gender:

Age:

Please list any other pets and include their type (Dog, Cat, Bird, Reptile, Rabbit, etc.), breed, gender, and age:

Can you provide proof all your pet(s) are current on required vaccinations? *

Can you provide proof that your pet(s) are spayed/neutered, if required? *

Have you ever given up a pet to a shelter? *

If yes, explain:

How many hours a day will your new pet be without human companionship and why? *

Where will the animal be when you are not at home? Example: outside in the yard, crate, baby gate, free run of the house/ dog door): *

Where will the animal be when someone is home? Example: free run of house with dog door, outside in yard, with me, crate, in my bed, in dog bed):

Day? *

Night? *

What is your backup plan for your animal if you are unable to care for him/her?: *

Will you be able to live with hair on your furniture, stains on your rug, and a warm body on your bed for the next 10-20 years? *

All pets transitioning to a new home need time to adjust to a new family/surroundings and may require housetraining & behavior training. Are you willing to provide all necessary training? *

What behaviors, if any, would cause you to give up your companion animal?: *

How do you plan to prevent your dog from digging out of your yard?: *

When your dog is outdoors at home, which of the following will apply:

Other:

Can you afford veterinary care, grooming, emergency expenses, supplies, and food for the lifetime of this pet? (These expenses can add up to over $1000 each year.) *

With existing pets, what is the plan for integrating your new pet safely and successfully into the household?

How did you hear about us?

Other:

Care and Training:

What training experience do you have with the breed of dog you are adopting? *

What training education do you have with the breed of dog you are adopting? *

Please detail the type(s) of animals and training philosophy you have used. *

Have you worked with under-socialized or unsocialized dogs? *

Have you worked with fearful dogs? *

Will you work with a dog that has special rehabilitation requirements? *

Will you take your dog you adopt from us to obedience training? *

Will you be training or utilizing this dog(s) for any particular type of work? *

How do you plan to exercise your dog, number of hours per day? *

How have you disciplined your dog in the past? *

How will you discipline this dog? *

If you are adopting a puppy, are you familiar with the use of a crate to train and/or confine the puppy in your absence or when you are not able to adequately supervise a puppy to keep him or her out of trouble or harm?

What kind of crate do you have?

What size is the crate?

What will you do with your dog when you go on vacation? *

If you move, what will you do with your dog? *

If you are unable to care for your dog in the future, who will accept responsibility for its care? *

What heartworm preventative will you use?

What tick preventative will you use?

What steps will you take to control fleas?

Pets Return Home requires that all dog(s) be spayed/neutered prior to adoptions, do you have any questions about this policy? *

If yes:

We try to follow up on the welfare of our adopted dogs, will you allow us to visit and call? *

Please feel free to add any other information that you think might be helpful to us in evaluating your Adoption Application?

References (List two personal references - one reference who is NOT a family member)

Reference One

Name: *

Address:

City:

State:

Zip:

Email:

Home Phone:

Cell Phone: *

Reference Two

Name: *

Address:

City:

State:

Zip:

Email:

Home Phone:

Cell Phone: *

Your Veterinarian

Name: *

Address:

City:

State:

Zip:

Email:

Phone: *

Date of last visit?

I certify that to the best of my knowledge, all the above information is true. I understand Pets Return Home reserves the right to deny the adoption of any dog.

I acknowledge that information regarding the breed, history, health, and behavior of adopted animals may not always be available and accurate.

I acknowledge that failure to complete this form in its entirety and/or knowingly omitting pertinent information may cause my application to be declined.

I acknowledge that this application is required in order to adopt a dog(s) from Pets Return Home but that by submitting the completed application is not a guarantee that my Adoption Application will be approved; it is merely the first step in the adoption process.

I acknowledge that Pets Return Home is a group run exclusively by volunteers who donate their spare time, and, as such, the adoption process may take more than one to two weeks to complete.

I acknowledge that once personal and veterinary references are approved, a home visit with a Pets Return Home volunteer is mandatory in order for me to be approved to adopt a dog from Pets Return Home.

I acknowledge that it is my responsibility to be aware of and abide by state and county laws associated with dogs, as well as the adoption of Northern Breed and/or Wolfdog hybrids.

Name: *

Date: *