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Please be honest when completing this application. There are no wrong answers. The questions are designed to help place our dogs in the right homes.

Name of dog you are interested in, if applicable:__________________

TELL US ABOUT YOURSELF:

Name (primary owner of the dog)_________________________ Age____________

Email address:__________________________________________________________

Home Address _________________________________________________________

City, State_________________________________________Zip ____________

Home Phone _________________________ Cell Phone: ________________________

How long in current home? __________________________________________

Employer ________________________________________________________

How long at current job?_____________________________________________

Name (co-owner of the dog)______________________________ Age __________

Email Address ____________________________________________________

Cell phone:____________________________ Alt Phone:_______________________

How long in current home?________________________________________________

Employer _____________________________________________________________

How long at current job?________________________________________________

Number of People in household, Total: _____

Number of Adults _____

Number of Children _______ Age(s) ________________

Does anyone in the house smoke? Yes ____ No _____

Is everyone in the household in agreement about adopting a new pet?

Yes ___ No ___

Does anyone in the household have any known animal allergies?

Yes ___ No ___ If yes, please specify _____________________________________

TELL US ABOUT YOUR HOME:

Do you:

Own_____ Rent____

What type of dwelling is it?

House _______ Condo_________ Townhouse_________ Apt________

Is your yard fenced in? Yes _____ No______

If so, what is the height ____________

Type of fencing___________________

Are there any breed/size restrictions where you live (e.g., by apartment management, condo or homeowner’s association)? Yes_____ No______

If so, what is restricted? _____________________________________________

If you rent, please provide your landlord’s name & contact information:

Name____________________ Phone______________ Email_____________________

By providing your landlord’s information, you are giving Dogma Pet Rescue permission to contact your landlord.

If you rent, have you already paid a pet deposit (if required)? Yes_____ No______

TELL US ABOUT YOUR PETS:

Is the dog you are interested in adopting going to be your first pet? Yes____ No_____

Did your family have pets when you were growing up: Yes_____ No______

If the dog is not going to be your first pet, please complete the following:

CURRENT PETS:

Please list all cats & dogs currently in your household:

CAT OR DOG

NAME

BREED (if dog)

AGE

SPAYED/NEUTERED

PREVIOUS PETS:

Please list all cats & dogs you have owned during your adult life:

CAT OR DOG

NAME

BREED

(if dog)

SPAYED/ NEUTERED

DURATION CARED FOR/WHAT HAPPENED TO YOUR PET

Please use a separate sheet of paper if you need more spaces.

Have you ever turned an animal into a shelter? If yes, please explain.

_______________________________________________________

__________________________________________________________________

_______________________

Please provide contact information for your veterinarian:

Name ___________________________________________________________

Address _________________________________________________________

Phone _____________________________ Fax __________________________

What do you know about Heartworms?

By providing your veterinarian’s information, you are giving Dogma Pet Rescue, Inc.

permission to contact your veterinarian. You also are giving permission for your

veterinarian to provide Dogma Pet Rescue, Inc. with a reference.

TELL US ABOUT ADOPTING YOUR NEW DOG:

Where will your new pet be kept (please be specific)

During the day? ___________________________________________________

At night? _________________________________________________________

How many hours during the average day will your pet be alone without a human? ______

If your new pet is a dog, how do you plan to provide exercise for it (check all that apply)?

___ Leash Walk Everyday

___ Will Have Cable Or Dog Run in Yard

___ Will Be Free To Run in Fenced Yard

___ Will Have Supervised Access to unfenced yard

___ Will be Free to Roam Around

___ Will Take Dog to Dog Park

How long have you been considering adopting an animal? __________________

In the event you/someone in your home were unable to care for your adopted pet,

who would be responsible for the animal’s needs? ___________________________

Please indicate age, breed and other desired characteristics that you are looking

for in your new dog: ___________________________________________________________

Please tell us why you are interested in adopting? Check all that apply:

___ Companion for Self ___ Companion for Family

___ For Breeding ___ Gift

___ For Protection ___ For Child

___ Replace Previous Pet ___ Companion for Other Pet

___ Other, please specify ___________________________________________

Are you prepared to spend several weeks or, perhaps months, waiting for your

new pet to adjust to a new environment? Yes ___ No___

Do you anticipate any major changes in your life that could affect a pet, such as a

move, new baby, change of job/schedule, in the next year? 2 years? 5 years?

Please explain. _______________________________________________________

__________________________________________________________________

_______________________

I certify that the above information is true and understand that false information may

result in nullifying this adoption. Also, if an omission or untruth is discovered after an

adoption takes place, I understand that Dogma Pet Rescue, Inc. reserves the right to

annul the adoption and reclaim the animal. I give Dogma Pet Rescue, Inc. permission to

fully investigate the information provided as well as contact veterinarians, landlords, etc. I

give permission for my veterinarian to release any information asked by a representative

from Dogma Pet Rescue, Inc. If the application passes this review, I agree to a home

visit on a mutually agreed date and time by a Dogma volunteer before an adoption decision is made.

______________________________________ _____________________

Signature (for electronic transmitting purposes, Date

your typed name will serve as a signature)

Our adoptions are decided on what is the best match for the animal and its potential family,

not on a first come first serve basis. We reserve the right to refuse an adoption.

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