Dogs Name: ID Number: Breed: Color: Age: Sex: Name: Date: Spouse / Roommate: Address: City: State: Zip: Phone (Home): Cell Phone: E-Mail: Occupation: Employer: Work Phone: Spouse’s Occupation: Spouse’s Employer: Spouse’s Work Phone: Requirements to adopt a dog from Dreamland Animal Rescue: • A willingness to allow the dog to live in the house and be a part of the family. • Securely fenced back yard if the dog is to be outdoors unattended. • No dog can be staked, chained, or tied in any way!
A successful adoption depends on both the selections of the right dog for your household and the understanding of his/her care taking needs. So that we may assist you with this selection, please answer the following questions as completely as possible. Your confirmation and answers to these questions help us to know that you completely understand the responsibility you take on when you adopt a rescue dog.
1. Do you live in a: House: Apt.: Mobile Home: Other (please specify):
2. How long have you lived there:
If less than 2 years, give previous address:
3. Do you rent? Yes No
4. If “Yes” Do you have your landlords permission to have a dog? Yes No
5. May we contact your landlord? Yes No Landlords Name: Phone: Date to contact:
6. Name of veterinarian / hospital: Vet Phone # Estimated annual cost for medical care
7. Do you have a fenced area for the dog? Yes No
8. If yes, type of area: Kennel (size) Yard (size)
9. Type of Fencing? Height of fence
10. If not, what arrangements will you have for the dog\'s exercise and toilet duties?
11. How do other family members feel about getting a dog?
12. Is anyone home during the day? Yes No At night? Yes No
13. Are you willing to house train the dog if necessary? Yes No
14. Where will the dog be kept during the day?
15. At night?
16. When you are away from home?
17. Do you agree to provide medical care (Annual shots, deworming, heartworm preventative, etc.) for the dog that you adopt? Yes No
18. Do you agree to provide fresh food and water daily for the dog you adopt? Yes No
19. Are you willing to allow this dog to be a part of your family?Yes No
20. We do not allow any of our rescue dogs to be staked, tied, or chained in any manner.Do you agree not to stake, tie or chain your dog? Yes No
21. If you adopt a dog, do you understand that the dog must wear a collar with current rabies tag and I.D. tag at all times? Yes No
22. If for any reason you cannot keep the dog, do you agree to return the dog to Dreamland Animal Rescue?Yes No
23. Do you agree to phone calls to check on the welfare of the dog? Yes No
24. Would you object to an inspection of your premises by a DLR representative Yes No
25. Will this dog be kept: Indoors: Outdoors: Both:
26. Is anyone in your household allergic to animals? Yes: No:
27. Have you owned a dog before? Yes: No: if yes, what happened to them? (if deceased, please state cause of death and how long ago):
28. What other animals do you currently own? # of dogs: # of cats:
29. Give breed, sex, ages and if they have been spayed / neutered for all pets:
30. When were they last vaccinated?
31. List the names and ages of all children living at home:
32. Who will be responsible for feeding, grooming and training your new dog?
33. Under what circumstances would you not keep this dog? Divorce: Move: New baby: New Job: Illness: Other:
34. Why do you want a Dog? (please number as many choices as apply in order of importance :1,2,3) For children: ; Companion: ; For spouse: ; As a gift: ; For other pet: For protection: Other:
35. How did you learn about this dog? Website Radio Petfinder TV Channel: Newspaper: ; Other:
If adopting puppy/dog under one year old please answer the following questions:
1. Have you ever owned a puppy before?Yes: No:
2. Are you aware that puppies like to chew on just about anything including clothing, furniture, cords, etc.? Yes: No:
3. How do you plan to address these chewing problems?
4. Are you familiar with crate training? Yes: No:
5. Would you be willing to crate train your adopted puppy? Yes: No:
6. Do you and your family have the time it takes to care for and train a puppy? (Please elaborate)
7. Would you be willing to take the puppy to dog training classes if necessary? Yes: No:
8. Are you aware that puppies need a series of vaccinations that you would be responsible for making sure the puppy gets? (Note: Puppies will be up to date on vaccinations at the time of adoption, but may require boosters depending on age) Yes: No:
All of the information I have provided on this application is to the best of my knowledge, true and complete. I understand that falsifying answers on this application, or at any other time during the adoption process, disqualifies me from adoption.
Signature: Date
