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Date:
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Interested in:
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Dog
Puppy
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Animal's Name:
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Animal's Name, second choice:
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What is your reason for wanting to adopt an animal?
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Are you adopting for:
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Yourself
family
others
gift/surprise
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Age of applicant:
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Age of co-applicant:
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Do you live with your parents?
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Yes
No
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Name:
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Address:
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City, State, Zip:
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Home phone and cell:
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Email Address:
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How long have you lived at present address?
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Do you live in a:
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House
Apartment
Condo
Mobile Home
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If renting, Landlord's name and phone number:
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How many adults reside in your home?
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Children and ages:
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Are all household members in agreement with adopting this pet?
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Do any members of the household have any allergies?
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If so, describe:
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Who will be responsible for taking care of the pet?
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What arrangements have you made to care for the pet in case you can no longer do so?
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Do you presently have any pets?
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If yes list breed(s), age(s), sex, and name(s):
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Are they spayed/neutered?
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Current on vaccines?
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On heartworm prevention?
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What other pets did you have in the last ten years?
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How long did you have them and where are they now?
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Were they spayed/neutered?
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Current on vaccines?
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On heartworm prevention?
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Who is your current/previous veterinarian? (clinic name and phone number):
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How much time do your current/previous pets spend outside?
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How much time would this new pet spend outdoors?
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How many hours per day will this animal be left alone?
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Where will the pet be kept when left alone?
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The average cost per year for providing preventative veterinary care is $150-$250. Additionally there are expenses of food, toys, grooming, boarding, emergency vet care, etc. to consider, does your household budget allow you to comfortably cover these expenses?
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Rescue animals require time to adjust to their new home. What amount of time do you consider to be reasonable for adjustment?
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The yard is:
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Completely fenced
partially fenced
not fenced
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The fence is:
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Chain link
privacy fence
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How do you plan on exercising this dog?
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Are you willing to enroll this dog obedience training?
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If no, what are your plans for training this dog? (Be specific)
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What behaviors would you be unable to tolerate from an adopted dog? (check all that apply)
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potty accidents
jumping up on furniture
playing in early am hours
barking
getting into garbage cans
counter surfing
getting on furniture
hiding from guests/other family members
shedding hair on furniture/clothes
chewing
escaping
fighting
digging
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other:
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Methods I plan to use to discourage unwanted behavior(s): (check all that apply)
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yell
put dog in another room
remove problem item(s)
put dog in crate
spritz with water
put dog outside
I won't tolerate bad behavior
swat/spank/hit with newspaper
throw something at dog
who cares dogs are dogs
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other:
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The above information that I have provided to WAG Animal Rescue for the purpose of adopting an animal is accurate and complete.
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Name and Date:
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