Dog Adoption Application

APPLICANT INFORMATION

APPLICANTS MUST BE 18 OR OLDER.

Adoption Applicant *

First

Last

Applicant 2

First

Last

Address *

Address Line 1

City

State / Province / Region

Postal Code

Mobile Phone *

Home Phone

Email *

Employment Status *

Employed
Student
Retired
Other

Please provide details *

DOG INFORMATION

What dog are you interested in adopting?

Name *

Colors *

Age *

Breed *

Gender *

FAMILY INFORMATION

Please tell us about you and your family.

Does anyone in your home have pet allergies? *

Yes
No

If yes, what is the guarantee this animal will stay with the family and not be returned because of the health reasons? *

What type of home do you reside in? *

House
Condo
Duplex
Apartment

Do you own or rent your home? *

Own
Rent

Please provide landlord’s name: *

Landlord’s phone number: *

How long have you been at your current address? *

Do you have children at home? *

Yes
No

What are the ages of your children? *

Are the children accustomed to and educated about animals? *

Yes
No

For what purpose and for whom are you adopting the dog? *

Have you ever owned a dog before? *

Yes
No

If yes, how long did you have it and if you no longer have it, what happened to it? *

Do you presently own any other animals? *

Yes
No

Please specify past and present animals in your home, including name, age, breed, gender, if they are spayed/neutered and if their vaccines are up to date. *

Have you ever owned any other animals in the past? *

Yes
No

If yes, what did you have, how long did you have it and if you no longer have it, what happened to it? Include name, age, breed, gender, if they were spayed/neutered and if their vaccines were maintained. *

Please provide the name of the veterinary clinic your animal(s) attend, did attend or will attend. *

Please provide the phone number of the above veterinary clinic. *

What will you do with this dog if you move? *

REFERENCES

Please provide the name and phone number of two (NON-FAMILY) references that are aware of you and/or your families’ interaction with pets (ie: vet, neighbour or friends):

Reference 1 *

First

Last

Phone *

Reference 2 *

First

Last

Phone *

REGARDING THE DOG

Do you have a secure and completely fenced yard? *

Yes
No

If no, what are your plans for keeping this dog securely in your yard? *

What height is the fence? *

What material is it constructed with? (wood, chain-link, etc) *

Are your gates locked and secure? *

Yes
No

If no, what are your plans for keeping this dog securely in your yard? *

Are you willing to give this dog at least 1 month to be accepted by your current pets and vice versa? *

Yes

How much time are you able to spend with this dog per day? *

4 hours or less
4-8 hours
8 hours or more

How and where do you plan on exercising this dog? *

Where will the dog be kept when you are not home? *

Under what circumstances would you be likely to give up this dog? *

If the dog showed behavioural problems how would you correct its behaviour? (ie: biting, growling, potty accidents, food or toy aggression) *

Would you be willing to contact Persian Dreams & Canine Themes Rescue Society for advice and suggestions to help you and your dog to be successful if there are behaviour concerns? *

I/We would be willing to contact PDCT for advice.

Are you aware that the average adult dog costs approximately $1,500 per year to maintain? *

I/We are aware of the costs.

Are you comfortable with this financial commitment? *

I/We are comfortable with the financial commitment.

Dogs often live for up to 12 years or longer. Are you comfortable in making this long term commitment? *

I/We are comfortable with this commitment.

ADDITIONAL INFORMATION

Do you have any additional information you would like to share with us? *

Yes
No

If there is anything additional you would like to add, please do so here: *

ADOPTION TERMS

Please read and agree to the following adoption terms:

I/We agree to give Persian Dreams & Canine Themes Rescue Society authorization to any veterinary records regarding previously/currently owned pets as provided by our veterinarian *

I/We Agree

I/We agree to have a home check done prior to taking our new companion home and a post home check and/or phone calls to see how the dog has adjusted. Follow up phone calls and/or home visits will be done for one year following the adoption. *

I/We Agree

I/We understand as part of the adoption contract the adoptive dog and I/We must be registered for obedience training with a training facility that teaches positive reinforcement within three months of adoption. Are you able to meet this commitment *

I/We Understand

I/We agree to pay the stated adoption fee and understand that it is non-refundable. *

I/We Agree

I/We agree to provide our new companion with a good quality dog food, appropriate shelter, exercise, veterinarian checkups, and love. *

I/We Agree

I/We agree to not tether this dog at any time. *

I/We Agree

I/We agree to cover any new, intermittent or ongoing medical expenses that may arise with this dog. *

I/We Agree

I/We understand that Persian Dreams & Canine Themes cannot be held responsible for any health, temperament or training issues and hereby release them of any liability. *

I/We Understand

I/We understand that our pet has been in foster care and that the foster home has adequately answered any and all questions to my/our satisfaction. *

I/We Understand

I/We agree that if for any reason we are no longer able to keep this dog we will return it to Persian Dreams & Canine Themes Rescue Society. *

I/We Agree

I/We agree to the above statements and believe that all the information we have given on this application is complete and correct. *

I/We Agree

ADOPTION TERMS ACCEPTANCE

Applicant Signature *

Date *

Applicant 2

Date

Dog Adoption Application

APPLICANT INFORMATION

DOG INFORMATION

FAMILY INFORMATION

REFERENCES

REGARDING THE DOG

ADDITIONAL INFORMATION

ADOPTION TERMS

ADOPTION TERMS ACCEPTANCE

The information provided in this document is confidential and will only be shared with the adoption applicant’s consent.