To Apply: Please Copy & Paste the below application into the contact form at the bottom of the page. Complete the application and hit submit!
Adoption application The Second Hand Dog Rescue Adoption Application Form (SHDR) [email protected] Contact Information
Full name: ______________________________________________________________
Occupation: ______________________________________________________________
Address: ______________________________________________________________
How long at this address: ___________________________________________________
Daytime Phone: ___________________________________________________________
Evening Phone: __________________________________________________________
Best time to call: ___________________________________________________________
Email address: __________________________________________________________
Family & Housing How many adults are there in your family (their relationship to you)? _________________________________________________________________________
How many children (ages)? _________________________________________________________________________
What type of home do you live in single family, town home, apartment, farm, etc.? _________________________________________________________________________
Please describe your household: __ Active __ Noisy __Quiet __ Average
If you rent, please give the rules governing pets and the landlord’s name and number: (by providing this information you are allowing SHDR to contact your landlord please inform them of this call so they will speak with us)
Does anyone in the family have a known allergy to dogs? _________________________
Is everyone in agreement with the decision to adopt a dog? _________________________
Do you have time to provide adequate love and attention? _________________________
Other Pets:
What other pets do you have (specify type and number)? Are these pets up to date on vaccines? _________________________________________
Are these pets spayed/neutered? If not..why?____________________________________ _________________________________________________________________________
Have you every surrendered a pet? If so, why? _________________________________________________________________________
Have you ever had a pet euthanized? If so, why? _________________________________________________________________________
Have you ever lost a pet to an accident? _________________________________________________________________________
How do you discipline your pets and why? _________________________________________________________________________
Veterinarian Do you have a regular veterinarian? __ Yes __ No
Veterinarian’s name: _______________________________________________________
Clinic Name: _______________________________________________________
Clinic Address: ________________________________________________________
Clinic Phone: ________________________________________________________ (Providing SHDR with this information you are allowing SHDR to call your vet. Please call your vet and ask them to authorize the release of information to SHDR.)
About the Dog You Wish to Adopt
What is your idea of an ideal dog and why?
Desired age: __________
Desired Size: _____________________________________
Desired breed: _______________________________________________________________
Breed you would not adopt:_____________________________________________________
Desired sex: _ Spayed Female _ Neutered Male _ No preference
Willing to adopt: __ outgoing/hyper dog __ shy dog __ dog that needs regular medication __dog that needs training __ dog that needs grooming__ None of these
Where will the dog spend the day? (describe) _________________________________________________________________________
Where will the dog spend the night? (describe) _________________________________________________________________________
Number of hours (average) dog will spend alone? _________________________________
Who will have primary responsibility for this dog's daily care? _______________________
Who will have financial responsibility for this dog? ________________________________
Do you agree to provide regular health care by a Licensed Veterinarian? __ Yes __ No
Do you agree to keep the dog as an indoor dog? __Yes __No
When the dog goes out, how do you plan to supervise it? Fenced yard?
Do you agree to contact SHDR if you can no longer keep this dog? __Yes __No
Are you be willing to let a representative of SHDR visit your home by appointment? __Yes __No
How did you hear about SHDR? _____________________________________________________
Would you be interested in fostering? __Yes __No __
Would like to know more:
Personal References Please list someone who is familiar with both you and your pets.
Name:_____________________________________
Address: __________________________________
Phone: ____________________________________
Relationship (relative, neighbor, friend, etc.)
All of the information I have given is true and complete. Thisdog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.
____________________________________ (Signature)(Date)
Full name: ______________________________________________________________
Occupation: ______________________________________________________________
Address: ______________________________________________________________
How long at this address: ___________________________________________________
Daytime Phone: ___________________________________________________________
Evening Phone: __________________________________________________________
Best time to call: ___________________________________________________________
Email address: __________________________________________________________
Family & Housing How many adults are there in your family (their relationship to you)? _________________________________________________________________________
How many children (ages)? _________________________________________________________________________
What type of home do you live in single family, town home, apartment, farm, etc.? _________________________________________________________________________
Please describe your household: __ Active __ Noisy __Quiet __ Average
If you rent, please give the rules governing pets and the landlord’s name and number: (by providing this information you are allowing SHDR to contact your landlord please inform them of this call so they will speak with us)
Does anyone in the family have a known allergy to dogs? _________________________
Is everyone in agreement with the decision to adopt a dog? _________________________
Do you have time to provide adequate love and attention? _________________________
Other Pets:
What other pets do you have (specify type and number)? Are these pets up to date on vaccines? _________________________________________
Are these pets spayed/neutered? If not..why?____________________________________ _________________________________________________________________________
Have you every surrendered a pet? If so, why? _________________________________________________________________________
Have you ever had a pet euthanized? If so, why? _________________________________________________________________________
Have you ever lost a pet to an accident? _________________________________________________________________________
How do you discipline your pets and why? _________________________________________________________________________
Veterinarian Do you have a regular veterinarian? __ Yes __ No
Veterinarian’s name: _______________________________________________________
Clinic Name: _______________________________________________________
Clinic Address: ________________________________________________________
Clinic Phone: ________________________________________________________ (Providing SHDR with this information you are allowing SHDR to call your vet. Please call your vet and ask them to authorize the release of information to SHDR.)
About the Dog You Wish to Adopt
What is your idea of an ideal dog and why?
Desired age: __________
Desired Size: _____________________________________
Desired breed: _______________________________________________________________
Breed you would not adopt:_____________________________________________________
Desired sex: _ Spayed Female _ Neutered Male _ No preference
Willing to adopt: __ outgoing/hyper dog __ shy dog __ dog that needs regular medication __dog that needs training __ dog that needs grooming__ None of these
Where will the dog spend the day? (describe) _________________________________________________________________________
Where will the dog spend the night? (describe) _________________________________________________________________________
Number of hours (average) dog will spend alone? _________________________________
Who will have primary responsibility for this dog's daily care? _______________________
Who will have financial responsibility for this dog? ________________________________
Do you agree to provide regular health care by a Licensed Veterinarian? __ Yes __ No
Do you agree to keep the dog as an indoor dog? __Yes __No
When the dog goes out, how do you plan to supervise it? Fenced yard?
Do you agree to contact SHDR if you can no longer keep this dog? __Yes __No
Are you be willing to let a representative of SHDR visit your home by appointment? __Yes __No
How did you hear about SHDR? _____________________________________________________
Would you be interested in fostering? __Yes __No __
Would like to know more:
Personal References Please list someone who is familiar with both you and your pets.
Name:_____________________________________
Address: __________________________________
Phone: ____________________________________
Relationship (relative, neighbor, friend, etc.)
All of the information I have given is true and complete. Thisdog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examination and vaccinations under the supervision of a licensed Veterinarian.
____________________________________ (Signature)(Date)