Adoption Application for ALPHA DOG RESCUE

The answers you give on this application will help us find the best possible match between you and the dogs available for adoption.
If any information on this form is omitted, your application will be discarded.
We reserve the right to refuse any applicant and/or inspect the home environment.
In addition, if we discover that any information on this application was knowingly falsified, we have the right to take back possession of the dog.
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   What are you looking for in a dog?
Is there a particular breed or specific dog you would be interested in?   
You want to adopt a:    Male Female No Preference
Preferred Age?   
Oldest dog you would be willing to accept?   
Would you be willing to accept a dog with some health problems?    Yes No Depends
Would you be willing to accept a dog with some behavior problems?    Yes No Depends
Are size or looks important to you?    No Yes


   Please complete your personal information
First Name: Last Name:
Street Address:
Address Line 2 (optional):
Town or City: State:    Zip Code:
Email Address:
Home Phone:
Best Time to Call:
Do you work?
Please Check   		 Full-Time    Part-Time    Retired    Work at Home    Don't Work
 
Employer:
Work Phone:
Personal Reference:

**REFERENCE MUST NOT BE RELATED TO YOU
Personal Reference Phone:
Personal Reference Email (optional):

**PLEASE PROVIDE EMAIL ADDRESS IF AT ALL POSSIBLE.


   About Your Home
What type of home do you have?    House    Apartment    Condominium    Duplex    Mobile Home    Other

Do You Own Or Rent?       Own    Rent
If you Rent, does your lease allow dogs?       Yes    No

**WE REQUIRE RENTERS TO SEND DOCUMENTATION THAT DOGS OF THIS SIZE ARE ALLOWED IN THIS DWELLING.
Landlord's Full Name:   
Landlord's Phone Number:   
Length of Time at This Address:    Less Than a Year     1 to 2 Years    3 to 5 Years     More Than 5 Years    
If Less than a Year:   
Is your Property Fenced?      Yes    No
If YES:   
If NO:   
Do You Have a Swimming Pool?      Yes    No
How Many Adults Live in Your Home?      
Ages of Adults in the Home?      
Your Marital Status:      Single    Married     Significant Other    Divorced     Widowed    
If There are Children in Your Home:   


   Your Plans If You Adopt A Dog
How Many Hours, on average, will the dog spend alone?   
If you move, what will you do with this dog?   
Where will the dog be when you are at home during the day? (Check all that apply):

Loose Indoors     Loose Outdoors in Fenced Yard     Crate     Basement     Tied or Chained Outside
Kennel Run     Garage     Other    

Where will the dog be when you are away from home during the day? (Check all that apply):

Loose Indoors     Loose Outdoors in Fenced Yard     Crate     Basement     Tied or Chained Outside
Kennel Run     Garage     Other    

Where will the dog spend the night? (Check all that apply):

Loose Indoors     Loose Outdoors in Fenced Yard     Crate     Basement     Tied or Chained Outside
Kennel Run     Garage     Other    


 
How will you discipline this dog?   
Do you plan to take this dog to obedience classes?   
Would you be willing to return any adopted dog that you received through us if you are unable to keep it for any reason?
Yes    No


   Your Pet Ownership History
Do you own any other pets?
Yes    No
Please give the name, breed, sex, and age of each:   
Are all of your pets spayed or neutered?
Yes    No
If the answer is no, please explain why not:   
Please list any Veterinarian(s) used for current or former pets.
If you do not have a veterinarian reference please provide the name, telephone number and (if possible) e-mail address of a second Personal Reference.
**APPLICATIONS SUBMITTED WITHOUT THIS INFORMATION MAY NOT BE PROCESSED.
Veterinarian Name:
Veterinarian Address:
Veterinarian Phone:
- OR -
Personal Reference:

**REFERENCE MUST NOT BE RELATED TO YOU
Personal Reference Phone:
Personal Reference Email (optional):

**PLEASE PROVIDE EMAIL ADDRESS IF AT ALL POSSIBLE.
Please list all pets you have owned in the past 5 years:   
If you no longer have them, please give details explaining what happened to them:  
If you have had a pet die at an early age or have ever lost a pet, please provide details:  
Have you ever given a pet up for adoption or put one to sleep?  

I affirm that by submitting this application with or without a signature certifies that ALL the information on this application is true and complete and that no one in the household where the pet will reside has ever been convicted of animal abuse:

Signature (Please type your full name):    Date:

~ Thank you for your interest in helping a dog have a second chance at life. ~