ADOPTION APPLICATION - Dutch Country Animal Rescue



ADOPTION APPLICATION

Completion of this application does not guarantee acceptance as an adoptive home/parent. Please note that we charge an adoption fee in the form of a donation for the adoption of our dogs.

$500 for dogs under 1 year old, $425 for dogs 1 to 7 years old, $325 for dogs 8 years or older. (Note that a discount will be given for the adoption of a bonded pair). Senior-to-senior program available. This fee helps to cover a portion of the costs incurred and enables us to rescue the next dog in need.

Our dogs are spayed/neutered prior to being adopted. For puppies that are too young to be altered prior to adoption, an additional $200 spay/neuter deposit will be required per puppy. You will be required to provide a proof of spay/neuter signed by your vet within 4 months of adopting the puppy at which time your $200 deposit will be refunded to you.

Please answer all questions to the best of your ability. ____________________________________________________________________________________

Today’s Date:

Applicant’s Name:

Home Address (Street, City, State, Zip):

Home Phone: Cellphone:

Email:

Current members living in your home:

Number of Adults: Number of Children and Ages:

Are all family members in agreement with bringing a new dog into your home?

Is there a specific dog that you are applying for today? (Yes/No)

If yes, please provide the name and breed of the dog:

Why do you want to adopt a dog?

What specific characteristics are you looking for in a dog?

Breed(s):

Gender:

Age Range:

Personality/other characteristics:

Are there certain characteristics that you will not be able to handle?

Are you applying for one of our puppy mill rescues? (Yes/No)

If yes, what previous experience do you have, if any, with puppy mill dogs and what would you expect a puppy mill dog to be like?

Are you applying for one of our special needs dogs? (Yes/No)

If yes, what previous experience do you have, if any, with a special needs dog?

Please list your current pets below (please use the back of form if more space is needed):

|Type of Animal |Pet Name |Pet Breed |Pet Age |Any Issues |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

Are your current pets spayed/neutered?

Are all of your pets current on vaccinations?

What became of the pets that you no longer have?

Have you ever had to turn a pet in to a shelter?

If yes, please explain when and why:

Have you ever had to put a pet to sleep?

If yes, please explain when and why:

Do any of your family members have allergies to animals?

Is anyone home during the day? (please explain)

Where will the dog stay while you are not at home?

Where will the dog sleep at night?

Will you crate your dog?

If yes, under what circumstances and for how many hours at a time?

Most rescues are not house trained. If the dog you adopt is not house trained, how will you house train the dog?

Where do you live? (House, Apartment, Condo, Mobile Home, Other)

Do you own or rent your home?

If you rent, we would like to contact the owner to obtain permission for this dog to live in your home. Landlord’s Name and phone:

If you live in a condominium, we would like to contact the homeowners association to obtain permission for this dog to live in your home.

Homeowners association contact name and phone:

Do you have a fenced yard?

If yes, what is the height of the fence?

If no, how will you contain your dog?

Will the dog spend the majority of their time indoors or outdoors each day?

Where will the dog stay if you go out of town for work or vacation?

Are you willing to have a representative of Dutch Country Animal Rescue come for a home check?

In what circumstances will you give up your dog?

Please give contact information for your veterinarian:

Veterinary Clinic Name:

Address:

Phone:

Please provide two personal references:

|NAME |PHONE |EMAIL |

| | | |

| | | |

I understand that adopting a dog is a life-long commitment, including potty training and any other training necessary to help my dog transition into my home. I understand that I am responsible for the well-being of any animal placed in my care and know that I am required to return the dog to Dutch Country Animal Rescue immediately if I can no longer care for this dog. I certify that the information provided in this application is true.

I understand the adoption fee shown at the top of this application and have the funds to pay this fee.

_______________________________________________________________________________

Signature/Date

email a signed copy of this completed application to: adoptions@

or mail to us at: Dutch Country Animal Rescue, PO Box 10186, Pleasanton, CA 94588

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