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Adoption Survey/Application
What dog are you interested in adopting?
*
About You and Your Home
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Place of Employment
*
Work Phone
*
Home Phone
*
Cell Phone
*
Are you at least 21 years old?
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Yes
No
Which applies to you?
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Own your home
Rent your home
Live with parents
Other
How long have you lived in your home?
*
If applicable, please list your landlord name and phone number.
*
Who will be primarily responsible for the care of your new pet?
*
Do you have a fenced-in yard?
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Yes
No
Not fully fenced-in
If applicable, how high is your fence?
*
Please describe the type of home you live in.
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House
Townhouse
Apartment
Condo
Dorm
Mobile Home
Other
How many people live in your home, including yourself?
*
Do children under 18 live there? If yes, please list their name and age.
*
Have you ever surrendered or rehomed an animal? If yes, please explain:
*
How did you hear about The Princess Buttercup Foundation?
*
What Type of Pet Suits You?
Is this your first experience with a dog?
*
Yes
No
Do you have any preferences as to breed type, sex, age, size, length of hair?
*
Are any of the members in your household allergic to dogs? If yes, how will you manage your/their allergies to dogs?
*
Where will your new pet be when there is no supervision?
*
How many hours each day do you predict your new pet will be left alone per day?
*
Do you plan to crop/dock your new dog’s ears or tail?
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Yes
No
Maybe
What type of food will you be feeding your new pet?
*
What will you do if your new pet chews furniture or shows other destructive behavior?
*
What are your feelings on crate-training a dog? And, when do you believe it's necessary to use a crate?
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If your new pet develops a medical problem that becomes expensive, what would you do?
*
Why do you want to adopt?
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Please describe your ideal dog.
*
How will you keep your new pet confined to your property when outside?
*
Outside Kennel
Tie Line
Runner
Chain
Dog House
Fenced Yard
Garage
Other
Where will your new pet sleep?
*
Will your new pet be living outside?
*
Yes
No
Sometimes
Do you agree to have your home/yard checked before adopting?
*
Yes
No
How will you housebreak your new dog?
*
How will you correct your new pet if they do something wrong?
*
Under what circumstances do you believe are OK to give up/surrender a pet?
*
Do you currently have pets? If yes, please list their name, breed, sex, age, and if they are spayed/neutered, up-to-date on vaccines, and declawed (for cats).
*
Have you had pets in the past? If yes, what happened to them?
*
Do you currently have a veterinarian?
*
Yes
No
If applicable, what is your veterinarian’s name and phone number?
*
Personal References
- Please do not list anyone that lives with you.
Reference #1
*
First
Last
Relation to you:
*
Phone Number
*
Phone Number
*
Reference #2
*
First
Last
Relation to you:
*
Phone Number
*
Phone Number
*
AGREEMENT STATEMENT
By signing below, I certify that all the above information given is true, and I recognize that any misrepresentation of facts will result in losing my privilege of adopting a pet. I hereby authorize release/disclosure of any records and/or other pertinent information including employment verification, proof of tenancy, and veterinary/personal references. I authorize my veterinarian permission to release any vet care records and information about my current and past pets to The Princess Buttercup Foundation. I understand that any false information given on this application will automatically disqualify me from adopting from this rescue. I understand that this application is the property of The Princess Buttercup Foundation and that management reserves the right to deny my application if it deems unsatisfactory.
E-signature
*
Date:
*
Submit
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