Member? (Who?) Friend? (Who?)
Website? (Which One?) Petfinder? Yes No
Are you inquiring about a specific dog? Yes No
What is the name of the dog you are inquiring about?
The information you provide below will help us get to know a little more about you, and your home.
Today's Date:
First Name: Last Name:
Street Address:
City: State: Zip Code:
Birthdate:
Home Phone: Work Phone:
Cell Phone: Email Address:
How long at current address?
Is it a house, condo, apartment or other (please specify)?
House
Condo
Apartment
Other
Do you own or rent?
Own
Rent
If you rent, please provide the name and phone number of the property owner:
How many adults in the household?
Please list their names, ages and occupations:
How many children in the household?
Please list their names and ages:
If no children in the home, do grandchildren, nieces/nephews or other kids ever visit? Yes No
Who will be the primary caregiver for the new dog?
Does this person work away from the home? Yes No
How many hours per day will the dog be left alone?
Please explain how new dog will be secured when left home alone.
Do you have a securely fenced yard? Yes No
If so, what type of fence is it (wood, chain link, block wall, etc.)?
If your fence is not a solid privacy fence, how much space is between pickets or boards?
How high is your fence? Is there a doggie door leading to the yard? Yes No
If you have no fence, where and how often to you plan to take your dog to go potty?
Will the dog be on a leash? Yes No
Under what circumstances would you allow your dog to be off-leash?
Are there any areas of the house where the dog will not be allowed?
If so, how will you keep the dog out of them?
Will the dog be allowed on the furniture? Yes No
If not, how will you keep it off the furniture?
Will the dog be given run of the house when no one is at home? Yes No
Where will the dog sleep?
Will you use a crate for your new dog? Yes No
Have you ever trained a dog to respond to simple commands? Yes No
If so, could you describe your method?
How will you discipline your dog for undesirable behavior?
If your new dog is not housetrained, how will you housetrain it?
Are you aware that even housetrained dogs need a period of adjustment
List all animals that currently live at your home, including pets and farm animals: Stating specifically what the animal type is (Dog/Cat), animal name, animal breed, has the animal been spayed/neutered, is animal indoor
Advise general temperament of each animal inside the home.
List all present and past pets you have been responsible for as an adult: Stating specifically what the animal type is (Dog/Cat), animal breed, has the animal been spayed/neutered, is the animal indoor or
If the animal is living and not in your possession, why not? If animal is deceased, what happened?
If you have a cat(s), describe how you hope your new dog will interact with it:
How do you intend to exercise your new dog?
Do you have what you consider an active lifestyle or are you more the couch potato type?
Active Lifestyle
Couch Potato
Do you travel alot? Yes No
When you go out of town, what arrangement will you make for the care of your rescued dog?
Have you ever had a rescued dog before? Yes No Do you belong to any rescue groups? Yes No
If so, which groups and what type of animals are rescued?
Do you foster animals for this group? Yes No
Why do you want a dog (or another dog) at this time?
Why do you want a rescued dog?
What characteristics do you especially want in your new dog?
What characteristics do you not want in your new dog?
What will you do if your new dog has some unwanted characteristics?
What is the age range of the dog you hope to adopt?
What gender and why?
Very important
Somewhat important
Not at all important
How important to you is it that the dog already be housetrained?
Are you willing to adopt a special needs dog (requires medication, deaf or blind, etc.)? Yes No
Are you aware that toy dogs can be big barkers? Yes No
What will you do if your rescued dog barks a lot?
Please provide name and phone number of your current or previous veterinarian:
Please provide the names and phone numbers and relationship to you of two personal references, not including family members:
Do you agree to have a representative of Papillon Pals Rescue, Inc. visit your home prior to adoption? Yes No
Do you agree to a follow up visit after adoption? Yes No
Do you agree to pay an adoption donation of $200-$500,
Yes No
If anything were to happen to you that would prohibit you from keeping the dog, do you understand
Yes No
Please understand that the amount designated as an adoption donation is just that "a donation". If the dog is returned to Papillon Pals
Thank you for completing this application and thank you for wanting to give a forever home to one of our rescued dogs.
Please type your name here as acknowlegment and understanding of this form. Application Date
