Name
*
First Name
Last Name
Email Address
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Cell Phone
*
(###)
###
####
Alternate Phone
*
(###)
###
####
Is there a particular dog you are interested in?
*
Living Situation
*
Please indicate which best describes your current living situation (Please check all that apply).
If you rent, please provide the name and phone number of your landlord.
Does your home have a fenced in yard or area?
*
(Please check all that apply)
If you do not have a fence, how will you contain your dog?
Do you work outside the home?
*
How many hours will your dog spend alone during the day?
*
Where will your dog primarily be kept during the day?
*
Loose in house
Crated in the house
Outside in yard
Doggie Daycare
With a neighbor/friend/family member
Please list the names and ages of everyone who lives in your household.
*
What pets do you currently own?
*
Please provide Name/Species/Age/Breed and if spayed or neutered.
What pets have you previously owned?
*
Please provide Name/Species/Breed and length of time the pet was with you.
Current Veterinarian Name & Phone Number
*
Please indicate if you see more than one Veterinarian.
Please contact your Veterinarians to release your records so that we may process a reference.
Previous Veterinarian Name & Phone Number
Please contact your Veterinarian to release your records so that we may process a reference.
Have you ever had to re-home one of your pets?
*
If you have re-homed a previous pet, please tell us why.
How active is your home?
What issues would cause you to re-home your pet?
*
How active do you prefer your dog to be?
Does your family have any special needs?
*
Is there anything else you would like us to know about your home?
I agree to the Terms and Conditions:
*
By clicking the submit form button, I agree to the terms of service.
I understand that by clicking the Submit button on this adoption form, I attest that all statements made are true, and hereby authorize Real Dog Rescue, Inc. to contact my veterinarians for a reference in regards to providing information on medical and preventative care they have given to my current and past pets.
I understand that this also gives permission to perform background checks to ensure that the applicant is a suitable adopter for a pet, and does not have a history of animal abuse/neglect or other such offenses.
The information contained on this application in material to the decision to place a dog into a home and becomes part of the contract in the event a dog is adopted from Real Dog Rescue, Inc.
