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Date:
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Interested in: Dog's Name:
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2nd Choice:
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Name:
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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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Address:
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City/State/Zip Code:
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Home Phone #:
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Cell Phone #:
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Email Address:
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Do you live in a:
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House
Apartment
Condo
Mobile Home
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Other:
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If renting, Landlord's name and phone number:
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How long have you lived at present address?
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The yard is:
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Completely Fenced
Partially Fenced
Not Fenced
No Yard
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How high is your fence?
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The fence is:
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Chain Link
Privacy Fence
Invisible Fence
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If no fence, how do you plan on keeping your dog contained in the yard?
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Are you adopting for:
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Yourself
Family
Gift/Surprise
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Others:
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Why do you want this dog?
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Companion
Child's Pet
Hunting
Gift
Guard/Watch
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Other:
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How many adults reside in your home?
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Married
Fiance
Older-Children
Roommate
Parent
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Other:
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Number of Children:
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Ages of Children:
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Are all members of the household 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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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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List of all current Pets. Please include breed, name, age:
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Are they up to date on vaccines:
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Are they spayed/neutered:
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Are they on Heartworm Prevenative:
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List all previous Pets in the last 5 years. Please include breed, name, age:
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Were they up to date on vaccines:
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Were they spayed/neutered:
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Were they on Heartworm Prevenative:
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Does pet live inside/outside:
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How long did you have your pet?
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Why is pet no longer with you?
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Who is your current/previous veterinarian? (List clinic name AND PHONE NUMBER. Please contact your vet clinic and give permission to release your pet's information.)
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Are your current and previous pet listed under your name?
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If no, please list name:
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How much time do your current/previous pets spend outside?
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Where will this dog be routinely living:
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Inside
Outside
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If other, describe:
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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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There are costs involved in having a pet. The average cost of preventative veterinary care is $200-$500. 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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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 A.M. Hours
Barking
Getting Into Trash/Garbage Cans
Counter Surfing
Hiding From Guests/Other Family Members
shedding on Furniture/Clothing
Chewing
Escaping
Fighting
Digging
Biting
Inability To Get Along Wih Other Animals
Not Quickly Adjusting To Other Pets In The Home
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Methods I plan to use to discourage un-wanted behaviors:
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You understand that rescue dogs may have unknown medical history/problems?
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You understand that rescue dogs may have unknown behavior issues?
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Additional information you would like to provide to WAG:
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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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Signature:
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Date:
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