ADOPTION APPLICATION

Please enter as much information as possible. Fields in RED are required. This questionnaire will assist us in helping you find the perfect new family member.

Name of dog interested in adopting

Email Address Your Name Your Age

Street Address City State Zip Code

Home phone Cell phone

Please lists other people in your household:

Name Relationship Age

Name Relationship Age

Name Relationship Age

Name Relationship Age

What is your occupation?

Who is the primary caretaker of the dog?

What types of personalities do you find desirable in a dog?

Is everyone in the household agreeable to a new dog? Yes No

Does anyone in our household have allergies or Asthma? Yes No

If you have visitors, do you have a way to separate your dog from them if it is uncomfortable? Yes No

Please explain:

YOUR HOME AND LIFESTYLE


Type of Residence:

If you rent, please give your landlord's name and phone number:

Landlord Name Landlord Phone

Do you live in a deed restricted area? Yes No

How many hours a day would the dog be alone?
0-2 hours
2-4 hours
4-6 hours
6 or more hours


While you are away, will the dog be kept in a crate? Yes No

Where will the dog be kept while you are at home?

Where specifically will the new dog be kept during the day?

Where will the new dog sleep at night?

Do you have a fence? Yes No

If yes, what type? Wood Chain Link What height?

If you do not have a yard, how do you plan to exercise the dog?

Do you feel it is acceptable to let your dog off-leash in an open area? Yes No

Does your home have a doggie door? Yes No

Do you have a pool? Yes No

Have you ever house-trained a dog before? Yes No

If yes, what method did you use?



Are you willing to:

Crate-train? Yes No

Adopt a bonded pair? Yes No

Adopt a dog needing house-training? Yes No

Adopt a dog requiring ongoing meds? Yes No

Adopt a dog NOT reliable with children? Yes No

Adopt a dog that is handicapped or blind? Yes No

Adopt a dog that may have been abused? Yes No


CURRENT PETS IN YOUR LIFE


Do you currently have pets? Yes No

If no current pets in the home, how long ago did you have a pet and what happened to it?

Please list current pets:
Name Breed Age Male Female
Spayed or neutered? Yes No How did you acquire pet?


Name Breed Age Male Female
Spayed or neutered? Yes No How did you acquire pet?


Name Breed Age Male Female
Spayed or neutered? Yes No How did you acquire pet?


Name Breed Age Male Female
Spayed or neutered? Yes No How did you acquire pet?


Do you keep your pets outdoors or indoors? Indoors Outdoors

Do you keep your pets on heartworm preventative? Yes No

Are your pets up to date on their vaccines? Yes No


PREVIOUS PETS IN YOUR LIFE


Have you owned pets in the past? Yes No

Name Breed Age How did you acquire pet?
What happened to this pet?


Name Breed Age How did you acquire pet?
What happened to this pet?


Name Breed Age How did you acquire pet?
What happened to this pet?


Will your pets accept a new dog into the household? Yes No

Have you ever surrendered a pet to a shelter? Yes No If 'yes', what were the circumstances?




YOUR VETERINARIAN

**Please list the vet you currently use or the application will be delayed in processing.**

Current Vet name Current Vet phone number
Pets on account at current Vet's office


Previous Vet name Previous Vet phone number
Pets on account at previous Vet's office

PERSONAL REFERENCES


Please give us two personal references to contact:

Name Phone

Name Phone

Anything else you want to tell us?



By completing this application and signing below and pressing the submit button, I certify that I am at least 21 years of age and will assume all responsibility for the care and well being for the animal that I am adopting through UnderDog Rescue of Florida. I further agree that I will be contractually bound through adoption to:
  1. Take my dog to the vet at least once a year for an annual exam, shots, and heartworm check.
  2. Take my dog to a vet in a timely manner if ill.
  3. Maintain proper care, including monthly heartworm prevention and flea/tick treatments.
  4. Return my dog to UnderDog Rescue of Florida and ONLY UnderDog Rescue of Florida if for any reason I can no longer care for the dog in a loving and humane manner.
  5. Please note that we must be given notice of 3 weeks to arrange to take a dog back.


How did you hear about us? Please check all that are relevant.


  • TV news
  • Magazine Article
  • Newspaper story
  • Adoption event
  • Family or friend
  • Website/search engine
  • Petfinder
  • Other


Signature (Print Name):