Animal Companion Rescue Foundation

Adoption Application - Dog

Name:
Address:
City:	State:	ZIP:
Home phone:	Work phone:	Cell phone:
E-mail:

Employer Name:

If leasing, complex name:
and/or Management Co. & Office Phone:
How long have you lived at the above address?
Current housing: House Apartment Mobile Home Townhouse Condo
Do you own or rent your current residence? Own Rent
If renting, does your lease allow dogs? Yes No
May we contact your landlord? Yes No
Do you forsee moving in the near future? Yes No

How many people live in your household?
Do all members know that you plan to adopt a dog? Yes No
Are you and/or your spouse currently employed? Yes No
Do you live with your parents or relatives? Yes No
Are there children in the household? Yes No
What are their ages?

Does anyone in your household have pet allergies? Yes No
What kind?
You are interested in adopting for: Self Family Someone Else
Why do you want a dog?

Companion for self	Companion for other pet	Gift	Child's pet	Family pet
Security	Hunting	Yard dog

What type of dog are you looking for?
Size: Small Medium Large
Age:
Sex: Male Female
Hair length: Short Medium Long
Is being housebroken required? Yes No
Are you willing to take the dog to obedience training? Yes No
How many hours would the dog be alone during the day?

Please list any pets that currently live in your household:

Gender	Spayed/Neutered	Gets along with dogs/cats
M F	Y N	Y N
M F	Y N	Y N
M F	Y N	Y N
M F	Y N	Y N
M F	Y N	Y N
M F	Y N	Y N

How many dogs have you owned in the past?
Where are they now?

Has a dog died on your premises in the last three months from distemper, parvo, or unknown causes? Yes No
Where do your present dogs live? Inside Outside Inside/Outside
Where will your new dog live? Inside Outside Inside/Outside Basement Garage Doghouse Pen
Where will your new dog sleep? Inside Outside Inside/Outside Basement Garage Crate
How will your new dog be exercised? Walk Run Runner chain Fenced yard
Is there a yard available? Yes No
Is it completely fenced? Yes No
How high is the fence?
What kind of fence is it?
Are your current pets up-to-date on all of their vaccinations? Yes No
Are your present pets all spayed or neutered? Yes No
Do you object to spaying or neutering? Yes No

Vet or veterinary clinic name:
Phone:
What do you think annual preventative veterinary care for a dog would cost?
What do you plan to do with your dog when you go on vacation? Take on Vacation Board at Vet Board at Kennel Dog Sitter Other
If ``other'', specify:
What procedures will you use for housebreaking and/or destructive behavior?

Are you aware of the causes of and prevention for heartworms? Yes No
What would you use for flea and tick prevention?
Would you object to an ACRF representative conducting a home visit before and after the adoption? Yes No
Have you ever taken a pet to the shelter before? Yes No
If ``yes'', why?

Personal Reference

Name:
Address:
City:	State:	ZIP:
Phone:

Please note: ACRF is an independent non-profit organization. We will in no way be held responsible for any adult, minor child, and/or their property during the viewing process. In submitting this form, you attest that you agree to release ACRF and its representatives from all liability for any injury or damage that may be caused by the dog to any person or property in your party while in the adoption area.

Animal Companion Rescue Foundation (ACRF) reserves the right to refuse any adoption for any reason.

This application is property of ACRF.

By checking this box, you affirm that all information entered here is true to the best of your knowledge:

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