Name of dog(s) you're interested in
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Name
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Please list your name and your co-adopter's name
First Name
Last Name
Co-Adopter Name
First Name
Last Name
Your mailing address
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Telephone number*
Driver's License and State - if not provided - will be required prior to final adoption
How long have you lived in Arizona?
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How long have your lived at your current address?
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If less than 2 years, please list prior addresses for the past 5 years:
Annual Household Income
Three NON-Family References With Phone Number
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Current Vet Name and Phone Number
How many adults and children live in your home?
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Please include age of all children
Who will be the primary caregiver for this animal?
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How often do other children visit your home?
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Why are you interested in adopting this animal? Please check as many which apply:
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Please describe in your own words why you are interested in adopting a pet at this time.
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Have you ever cared for this type of animal during your adulthood before:
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What is the activity level in your home?
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Is everyone in the household in agreement on adopting a new pet at this time?
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Has anyone in the household been charged with domestic violance or animal abuse?
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Is anyone in the home ALLERGIC to Animals?
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Is your home
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Apartment/Condo
Single Family Home
Apartment
Mobile Home
Do you
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Own
Rent
If renting, do you know the policy of the complex, or landlord on dogs being allowed? A copy of your lease may be requested, and is mandatory to finalize the adoption.
Do you currently have other pets? Species, Breed, Spayed/Neutered/Chipped, for how long?
What will you do with your dog when you go out of town or on vacation?
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Does your job require frequent travel?
Have you lost a pet in the last 5 years?
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If yes, please provide details - when, where, what species, why?
Do you have a doggie door?
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Do you have a pool?
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Does the pool have a fence completely around it?
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If No Fence, do you plan on getting one installed?
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Do you have a fenced in yard?
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Please describe how tall your fence is, type of material, do you have a gate?
Have you relinquished an animal in the last 5 years?
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Reason that you relinquished an animal in the past 5 years:
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Please tell us about the pets you currently have at home:
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PLEASE INCLUDE THE FOLLOWING INFORMATION FOR EACH ANIMAL:
Animal Type
Spayed/Neutered
Microchipped
Up to Date on Shots
LIve Inside or Out
Still Alive
If deceased, reason and age:
If no longer living with you Reason why:
Male or Female
How long have you had them
If your animals are not spayed/neutered please explain why:
If your animals are not microchipped please explain:
Will you commit to this pet for its lifetime despite changes in your life?
Please explain
Are your current animals Dominant or Submissive?
If you currently own a dog(s) do they get along with other dogs?
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Where will the Dog be when you are not at home
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Do you plan on crating your animal when you are gone?
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How long will your animal be alone during the day?
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Where will your dog stay at night?
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Will this animal live:
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Animals need exrcise to stay happy and healthy - what type of exercise will this animal receive, and how often?
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How much are you willing to spend a year on medical expenses for your dog?
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If you had to move would you:
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What type of TRAINING do you see this animal needing?
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Who will provide this training?
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What type of behavior is unacceptable to your/your family?
How would you deal with this behavior?
Please provide a description of the home your dog will be living in (single family, apartment, trailer, condo with large or small yard
Is there anything else you can provide us about the life you will offering to this dog?
Your new dog is leaving his/her scent all over the house (marking) how would you handle this?
Your new dog is confrontational with other dogs, or people they meet (barking, growling, lunging etc.) how would you handle this?
You come home to a destroyed house (for example, furniture gutted and torn, blinds torn/chewed, trash all over, wall/doors damaged, etc. How would you handle this?
How would you go about teaching the dog what the word NO means? Would you smack the dog on the nose or butt, grab the collar, scruff him/her, give a leash correction, talk in a deep voice, scream, yell, try to dominate/intimidate or just hope the dog understand the word?
For which of these reasons would you give up a pet?
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I hereby agree that I will provide a copy of my drivers license, copy of rental agreement, HOA Bi-laws (Rules/Regulations) and/or copy of Lease Agreement, and agree to a home inspection if warranted and requested by the rescue. I further agree that my references will be contacted, and that all the information on this form is correct.
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First Name
Last Name
Date
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DD
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Co-Adopter Name
First Name
Last Name
Date
MM
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DISCLOSURE
