Dog Adoption Application "*" indicates required fields Applicant InformationDate* MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Primary Phone* Email* Employment*Full-timePart-timeRetiredOtherAre there additional adults in the household? Yes No Name of additional responsible adult in household* First Last Relation to Applicant* Phone Number* Household InformationDo you* Rent Own Type of Residence* Single Family House Multi-Family House Apartment Condo Mobile Home Live with friends/family members Landlord/Condo Association Name & Phone Number* Does your lease or HOA allow dogs?* Yes No Not Applicable Length of Time in Current Residence* How many adults in your household?* How many children in your household? What are their ages? How many pets in your household? If moving becomes necessary, what will you do with your pet(s) if you cannot find a residence that allows pets?*Are any members of your household allergic to animals?* Yes No Unknown Personal ReferencesMaximum of one family member, please.Reference 1* First Last Phone Number* Reference 2* First Last Phone Number* Pet OwnershipAre you a first time pet owner?* Yes, this is my first pet. No, I have owned pets before or currently own a pet(s). Pet InformationList pets that you own, or have owned in previous years.Please list the name, species, and breed (if applicable) of your previous pets.*Do you currently own a pet(s)?* Yes, I do currently own a pet(s). No, I do not currently own a pet. Please list the name, age, species, and breed (if applicable) of your current pets.*Are your current pets spayed/neutered?* Yes No If your pets are not spayed/neutered, please explain below.*Are all of your pets up-to-date with vaccinations?* Yes No If you currently own a dog, is it on heart worm preventatives?* Yes No N/A, I've never owned a dog before. Do your pets receive yearly wellness exams?* Yes No Veterinarian InformationPlease notify your vet to give permission to speak to us.Name of Veterinary Clinic or Hospital* Phone Number* Adoptable Animal InformationTell us more about the animal you'd like to adopt.Is there a particular dog you are interested in? If so, please provide their name. Why are you interested in adopting a dog at this time?* Companion for me/family Companion for another pet Other Other: What age dog are you looking for?* Young (1-3 years) Adult (4-8 years) Senior (9+ years) Size/Weight Preference (check all that apply)* 5-10 lbs 11-30 lbs 31-50 lbs 51-80 lbs 80+ lbs Doesn't matter Do you have a securely fenced yard?* Yes No What material is your fence? What is the height?* If you don't have a fenced-in yard, are you able to do any of the following (choose all that apply)* Install a fence Install a pen Install a run Leash walk Go for hikes Have you ever taken a dog to an obedience class?* Yes No How many hours per day will the dog be without human companionship?* Where will the dog be kept during this "alone" time?* Where will your dog sleep at night?* Are dogs allowed on the furniture?* Yes No Is this dog a gift?* Yes No How do you plan to exercise your dog?* Who will be primarily responsible for the care of the dog?* What is the activity level in your home?* Quiet - 2 or less adults/seniors, no children, applicant(s) home most days. Calm - Applicant(s) often home, 3 or less family members residing in the home, no young children Moderate - Applicant(s) work typical schedule (5 days per week, home most weekends. Active - Frequent visits by friends/family, multiple children, other pets, busy weekends – time spent out of the home What arrangements would you make for the care of your dog when you go on vacation or in the case of emergencies?*Do you plan to get a cat in the future?* Yes No Not Sure Do you plan to start a family?* Yes No Not Sure Do you believe you can provide a good home for your pet for its entire life, which could be up to 20 years or more?* Yes No Not Sure Under what circumstances might you decide not to keep your dog? (check all that apply)* New Job Moving New Baby Monetary Issues Problem with Dog's Health Problem with Dog's Behavior Conflict with Other Household Pets Illness or Allergies N/A Have you ever given up a pet for adoption or surrendered an animal to an Animal Shelter, Pound, or Rescue Organization before?* Yes No Behavior problems can arise for many reasons; most can be solved. Do you agree to seek help and assistance to resolve these issues rather than give up your pet should problems occur?* Yes No Not Sure Would you allow a Rescue representative to do a home visit?* Yes No How did you hear about Our Companions Animal Rescue & Sanctuary?* Website/Social Media Radio/Newspaper Advertisement Vet Clinic Family/Friend Referral Adoption/Special Event Previous Adopter Other Other: The following will be discussed when you are contacted:Adoption Donation Identification Adjustment to new home Health Care Behavior Problems Exercise Feeding Remember: The day you take home a new pet is the day you begin a very special friendship. While you’ll have many years together, your companion will never outgrow his/her need for you. We will happily provide information and advice to you on pet care and responsibility. Thank you for taking the time to complete this application.
